| ORDER FORM |
| Print this form then complete it. Include it along with your payment to |
| Your Name: Address: City: State: Zip Code: Telephone Number: Email Address: |
| Which style do you like? (Select) Full Background Past, Present & Future Topper Past, Present & Future II Make a Statement Artwork Standard Tilt No Boundries Dual |
| Total number of calendars ordered: |
| All Calendars are $25.00 and include: Scanning pictures, binding and Shipping |
| Total amount enclosed: |
| Special Instructions: |
| I have read the FAQs: (Please initial) |
| Forget the calendar, set me up an On-Line Photo Gallery: |
| On-line Photo Album set-up fee: $40.00 (Set-up includes scanning up to 24 photographs and building the album). Storage of on-line photos is free. |
| BACK to Main Page |
| Please return my Photographs (Select): YES NO NOTE: We will not return your photographs unless you specify for us to do so |
| Send form and check to: A.M. Gontarek 6701 Furrow Dr. Harrison TN 37341 |
| A.M. Gontarek 6701 Furrow Dr. Harrison, TN 37341 |