Agreement – Agora Gallery Forms

Thank you for signing the representation agreement!

Please use the following form if you are paying by credit card.

Payment Form – Gallery Representation

Please complete the contact details below and select the same representation option as you did on the agreement.

Name*
First Last
Email*
Representation Option*
Digital Promotion with Representation*
- 1 Payment Option - $3,450
- 3 Payment Option - $1,185 (1st payment)
- 6 Payment Option - $625 (1st payment)
- 12 Payment Option - $325 (1st payment)
Basic Representation*
- 1 Payment Option - $5,450.00
- 3 Payment Option - $1,925 (1st payment)
- 6 Payment Option - $985 (1st payment)
Standard Representation*
- 1 Payment Option - $9,250
- 3 Payment Option - $3,250 (1st payment)
- 6 Payment Option - $1,685 (1st payment)
Premium Representation*
- 1 Payment Option - $17,850
- 3 Payment Option - $6,050 (1st payment)
- 6 Payment Option - $3,100 (1st payment)
Total
$0.00
Payment Method*
Credit Card*

Card Details

Cardholder Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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