580 Pioneer Circle, Harleysville, PA 19438

    215-256-6759 or 1-800-378-4433

    Fax 215-256-1954

Your name/company:
Address:
Suite, apartment, or room number:
City, State, ZIP:
Primary phone:
Night/weekend/cell phone:
E-mail:

I want PhotoGraphic Specialties to produce the following items for me:
     ____ Sets of original 35mm slides in plastic mounts from my file at 4K [ ], or 8K [ ]
          I want 2 business day service [ ], 1 business day service [ ], same day service  [ ]
          I want Premium service [ ] or Standard service [ ]. (Standard service may result
          in rush charges if you have a deadline and there is a problem with your file
          requiring re-imaging it.)

     One set of slides at 4K [ ], or 8K [ ], and then ____ sets of duplicates from my originals
          (Ordering dupes from your originals will add one to two days to your order.)
          For the originals, I want 2 business day service [ ], 1 business day service [ ], or
          same day service  [ ]. I want Premium service [ ] or Standard service [ ].
          Number [ ] and then collate [ ] the duplicate slides
          Load the duplicates slides into plastic slide sheets [ ]

     ____ Sets of duplicate slides from the enclosed original slides
          Number [ ] and then collate [ ] the duplicate slides
          Load the duplicates slides into plastic slide sheets [ ]
     ____ Extra boxes [ ] or slide sheets [ ]

     ____ Sets of 4x5 inch transparencies at 8K from my file

     ____ Sets of color overhead transparencies from my file
          Overheads should be mounted [ ], unmounted [ ], sleeved [ ]

     ____ Sets 35mm color negatives at 8K from my file

     ____ dpi scans and digital files of type ____ from the enclosed originals


To make my files I used this program:                           version number:
     The name(s) of the file(s):
     There are this many total images:


Free delivery by Priority Mail [ ] or use my FedEx # _________________________.
     OR ship at extra cost by: Federal Express [ ], Express Mail [ ], or __________________ [ ].

Payment method:  Net 30 days (to established accounts only) [ ]
                 VISA [ ]    MasterCard    [ ] Amex    [ ] Discover [ ]
                 Card #:                            Exp. Date:
                 Verification code on back of card:
                 Name on card:
                 Signed: