Name __________________________________________________ Adress _________________________________________________ City ________________________ State ____ Zip _______________

All orders must be accompanied with a photocopy or original photo and number on back of print.

(Original will be returned)

Please use one order form per order.

Photo was taken at______________________________________

1-8x10-------------------------------------$14.00 ea. x_____= $_________

2-5x7---------------------------------------$14.00 ea. x_____= $__________

4-3.5x5------------------------------------$14.00 ea. x_____= $__________

8-Wallets---------------------------------$14.00 ea. x_____= $__________

1-3x5 Statuette-------------------------$10.50 ea. x_____= $__________

1-8x10 Statuette (+$10 two people)----$35.00 ea. x_____= $__________

S/H---------------------$5.00

Number from back of print

Subtotal ___________

R____ F ____

Tax 8% ____________

Total $ _____________

There will be a $35.00 Bank Charge for insufficient funds.

Pro Image P.O. Box 304 Port Crane, NY 13833 607-648-6043

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