Your Name: ___________________________________________________________

Address:   ___________________________________________________________

City/State/Zip: ______________________________________________________

Phone: ____________________ email address: ___________________________

* DESCRIPTION OF PHOTO YOU ARE SENDING:

  ______________________________________________________________________
               (i.e. man and two boys in front of barn)

Size of original: ______

This original is a (check):  ___ faded photograph
                             ___ damaged, scratch, hole, stain, etc.
                             ___ other? Please describe on back of form.

In order to make copies, a new negative must be made. The negative is yours
to keep upon completion and the negative will be archivally processed which
means that with proper storage the negative could last 100 to 300 years.

What size copy negative do you want?  ___  2 x 2 1/2 ...$15.50
         Please check                 ___  4x5 .........$20.00

** PRINTING WORK REQUESTED

Size and quantity of final prints wanted?  _______________________________
                                                 (i.e. 1 5x7, 3 8x10)
Please circle your choice for final prints:

Paper surface: Glossy or Matte (Pearl) ?

Fiber Paper: yes or no ?       Sepia toning: yes or no ?

Return shipping preference:  ___ UPS  ___ FedEx  ___ 1st Class Mail
         Please check        ___ Registered mail ___ Certified mail