First Name Last Name Company Address Address (cont) City State WA AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WI WV WY Zip Phone Fax

Email Number of Seats You Are Purchasing 1 2 3 4 5 6 7 8 9 10 Cost Per Seat $ + tax Coupon Code: Gift Certificate: Number:   Pin: Start a Group!  What's This? Group Name: (ex: Whitney's Birthday) Invitees Email Addresses: (separate multiple email addresses by a , (comma). Max: 15.) Notes: Are you meeting friends? What are the names of the members in your party? We will use this information to assign seats accordingly. Thanks! Credit Card Number: Credit Card Expiration Month January February March April May June July August September October November December Year 2013201420152016201720182019202020212022 CVV CVV:

Create a Group! Simply put in a group name and a list of email addresses and upon your signup we will email everyone in the list with a link to this signup page to paint on // at . This link will automatically fill in the Group Name field with the name you choose. Our hope is that this tool will make it easier for you to arrange an evening of fun with your friends!

CANVAS! paint & sip studio - 425.822.2266 - 122 Central Way - Kirkland, WA 98033
Copyright © 2012 Canvas! Art as Entertainment LLC. All Rights Reserved.