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Photo Order Sheet (please print clearly)

Name:                John Smith                                                    
Street Address:  101 1st  Street
 
City:                 Brownsburg
State:                IN Zip Code:  46112
Gallery Name: Family Name or Bride & Groom  Method of payment:  (mark one) Amt:$__________

for credit card payments complete bottom of form

 cash____    check #_1359____   credit card_______
Photo Name/number  Quantity    Size Description & special instructions       Price
 01 Bride (03)BW     1  8 x 10  black & white bride with bouquet   $  20.00
 07 Ceremony (22)     1  5 x 7   bride & groom kiss  
 10 Cake cutting (02)     1  5 x 7   groom feeding bride cake       20.00
 17 Dance (45)     1  4 x 6   bride & groom dance  
 11D Guys (09)     1  4 x 6   groom and groomsmen      
 06 Ceremony (35)     1  4 x 6   couple at alter       20.00
 10 bride & groom (22)     9 wallet   bride & groom sitting       20.00
         
         
         
         
         
                     Shipping     (add $2.00 for mailed orders)   $   2.00
         Total Payment enclosed   $ 82.00

For Credit Card Orders: mailing address must match billing address on your card

We may request verification of security code from the back of card via telephone

Print Name as it appears on credit card: ________________________________________________

       mark an X through type of card

Card Number: ________-________-_______-________       Expiration Date: _____/_____ (mm/yy)

Sign for credit card orders: _____________________________________   Date: ________________

Evening Telephone Number: (______)   _________-__________