ModifiedImaging:
 Image order form 1A:
Items preceded by an asterisk (*) are required for both, those preceded by two asterisks (**) are required for only online orders (***online orders not yet available***).

     Name: ___________________   ____________________
                *(first)                                   **(last)
** Address: ___________________

Image information:
Order Number:   Photo Title:           Photo Size:           PID Number:              Cost:          Quantity:

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                                                                                               Tax:

                                                                                      Total Cost:
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