Paintings That Heal™
Physical & Energetic Healing Art
Advancing Health.
Elevating Energy. Cultivating Wellness.
Client Information (1 of 3 rv1204) Date: _____________ Date Completed:_______________
Atlanta, GA office:
1.404.242.9022 NC Office: 1.910.692.5206 USA Email:
Brent@BrentAtwater.com
All client information is confidential. Please fill out
completely. Thank you.
NAME:____________________________________________________________________
(last name first) first middle nickname
BIRTHDATE:________________TIME:_____________PLACE:____________________
OCCUPATION:________________________________ Photo Sent:___________
HOME
ADDRESS:_______________________________________________________________
__________________________________________________________________
CITY: _______________________ STATE:________ PSTL
CD:_________COUNTRY:_______
HOME PHONE:______________________ EMAIL HOME: _______________________
HOME PHONE 2:_____________________ CELL PHONE:_____________________
OFFICE PHONE:_____________________ EMAIL OFFICE:_______________________
Referred by:____________________________________________TU_________________
Alternative contact:_______________________________________________
Phone:_________________________________________________________
Comments:
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Paintings That Heal™
Physical & Energetic Healing Art
Advancing Health.
Elevating Energy. Cultivating Wellness.
Commission or Purchase Details (PAGE 2 of 4)
Style and Quality: The Painting shall be executed by B. Brent Atwater in conformity with her established procedures, recognized style and standard of work.
Deposit: A 100% non refundable deposit is required to secure and reserve the time for the Painting's commission.
Sales Tax: Applicable sales tax will be added to the full amount of the agreed upon commission price.
Frame: The cost of framing is the responsibility of the client.
Travel: If the client wants the artist to visit their location, travel expenses plus food and lodging incurred by the artist to come to the client, shall be paid by the client and will be added to the agreed upon commission price.
Crating and Shipping: The cost of handling, crating and shipping shall be paid by the client, and the method of shipping shall be agreed upon at the time of commission. The client shall also pay insurance and delivery confirmation.
Approval: When B. Brent Atwater is present at the delivery of the Painting, the Painting shall be deemed accepted and received at the conclusion of that session. When the Painting is received by the client without the artist present, the Painting shall be deemed delivered.
Artist Default:
If the Painting is not completed because of death, incapacity, or default of
the artist for any reason, all moneys paid will be returned promptly to the
client.
Artist Copyright: B Brent Atwater, and or Energy Work Inc, and or
Collections Inc retains and owns any and all copyright interests in the
Painting, which includes but is not limited to any and all uses for
reproduction and licensing.
Disclaimer:
There are no guarantees about the healing properties of this artwork.
Paintings That Heal™
Physical & Energetic Healing Art
Advancing
Health. Elevating Energy. Cultivating Wellness.
by
PO Box 475 Southern Pines, NC 28388 USA
NC Phone: 1.910.692.5206 USA NC Fax: 1.910.692.5103 USA
Atlanta, GA Phone: 1.404.242.9022 USA
Email: Brent@BrentAtwater.com
Commission or Purchase Contract:
Paintings
That Heal™
by B Brent Atwater :
(1 of 2 pages, 3/4)
I, (Please print)
_________________________________________________ (the "Client"),
understand that B Brent Atwater, of Energy Work, Inc., is a medical
intuitive, intuitive consultant, healer,
and artist, and does not present herself
as a medical doctor nor as possessing any specific or formal medical
training, nor as a licensed, registered or certified practitioner or
counselor. I seek and it is my intent to hire
Ms. Atwater to create an
intuitive Painting for me.
I understand the following:
1. I seek and it is my intent to hire and commission Ms. Atwater to create a
Painting for me freely and of
my own accord without coercion or duress and
with full knowledge of the limitations of the Paintings that she offers. I
take full responsibility for getting appropriate mental, emotional, and
physical health care for myself.
If I have any symptoms, adverse reactions,
or illness, it is my responsibility to seek the care of a trained
medical
practitioner of my choice.
I, __________________________________________being the legally authorized
guardian, representative, or caretaker
of______________________________________________, seek and it is my intent
to hire and commission Ms. Atwater to create an intuitive Painting.
2. Ms. Atwater has advised me to disregard, not
participate in, nor use any intuitive information or suggestions that Ms.
Atwater provides that do not resonate with my personal choices, my
intuition, or my soul and to
consult with a trained medical practitioner and
my legal advisor before participating in any of her intuitive suggestions.
Ms. Atwater's intention in providing this intuitive Painting and any
intuitive information is purely
for information and art work and not for
medicinal or curative purposes and I take it as such. Her Painting is
not
guaranteed to
prevent, diagnose, mitigate, or cure any illness or disease, or any
emotional and or mental problems or personal problems. I have been
advised to consult with a trained medical practitioner and my legal advisor
for appropriate health care.
3. No one representing Energy Work and or Collections Inc., or Ms.
Atwater offers me any false hope, false expectations, promises, warranties,
or assurances of the success or the outcome of any of Ms. Atwater's
recommendations and or Paintings. I agree to hold Ms. Atwater, Energy Work,
Inc., Collections, Inc. and it's representatives free and harmless from any
liability, demands, claims, suits for damages for any injury or
complications whatsoever, save negligence, that may result from such
recommendations and or from any adverse reaction I may have
to the Painting, or to any intuitive recommendation.
4. I understand that in order to secure an appointment for a Painting,
payment by credit or debit card, certified check or pre approved personal
check is required. I understand
that my Painting's commission fee is
non-refundable as of my signing this agreement.
The size of my Painting
is: ______________________
The fee for my
commissioned Painting is $
__________________
and I agreed to that amount.
Commission or
Purchase
Contract
Paintings
That Heal™ by
B Brent Atwater :(2 of 2 pages, 4/4) |
5. I understand that by signing this contract, either as the client or as
the legally authorized representative for the client, that I agree to pay
the total amounts for Ms. Atwater's services (defined as: a commissioned
Painting) that I have contracted for now and or shall schedule with Ms Atwater
in the future. I also agree to and authorize the credit or debit card
referenced below, to be charged to pay for Ms. Atwater's services. See the
card information below. It is my intent and I agree to and authorize that
the total fees for Ms. Atwater's services up to the point of my or the
client's transition be paid for by my or the client's estate should that
become necessary.
6. I fully understand that are no guarantees for the healing properties of Paintings That Heal™.
7. I fully
understand and agree to the fact that B Brent Atwater, and or Energy Work,
Inc., and or Collections, Inc. retains and owns any any and all copyright interests in my
Painting, which includes, but is not limited to any and all uses for
reproduction and licensing.
I am eighteen (18) years of age or older, of sound mind, and not under any mind
altering drugs. By signing this agreement, I acknowledge that I have read
the above, have thoroughly reviewed and understand its contents, and that I
am giving my informed consent and it is my intent to agree to this
contract. By my written acceptance of this agreement, I know this document
becomes a legally binding contract.
SIGNATURE OF CLIENT OR
PERSON LEGALLY AUTHORIZED TO CONSENT FOR THE CLIENT, OR PERSON
CONTRACTING MS ATWATER'S
SERVICES
Signature:______________________________________Seal Date:
____________, 2004
1. Witness to
signature:___________________________________
Print Name:__________________________________________
Address:__________________________________________________________________________
2. Witness to signature:___________________________________
Print Name:__________________________________________
Address:__________________________________________________________________________
Please print the
following for the Signor if you are legally appointed.
Print Name: ______________________________________
Phone:__________________________
Address: _________________________________________________________
_________________________________________________________
__________________________________________________________
Relationship to
Client:__________________________________________________________
I understand that
by providing the following information to Ms.
Atwater and Energy Work, Inc. or Collections, Inc., that
I agree to and authorize, or have been legally authorized to provide the
debit or credit card below to be charged to pay for Ms Atwater's services.
This authorization may only be terminated by the individual or legally
authorized agent of said person who owns this card, and only by written
notification sent via certified mail to Energy Work, Inc. at the address
above:
This information is strictly confidential and secure. Type of
card:_________________________
The name as it appears on the
card:_____________________________________________________
Card number :______________________________ Expiration date on
card:_________________
The last three numbers on the signature strip:_____________
The Billing Name and Address as it appears on the
card's statements:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
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