Miles Of Memories Photography

 

368 Stonyhill Drive

Chalfont, PA 18914

267-210-3150

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ORDER FORM

 

 

 

 

 

Customer Name:_______________________________

Date:_________

 

Address:_______________________________________

 

 

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Event Name:_____________________

 

 

 

 

Event Date:______________________

Phone Number:________________________________

 

 

E-Mail Address:________________________________

 

 

(We will notify you by e-mail when we receive your order
and also when your order is shipped to you)

 

 

Image Number:

 

Image Size:

 

Quantity

 

SubTotals

 

(IE 145-6.jpg)

(IE 5X7, 8X10, 11x14, 16x20)

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          SubTotal 

 

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          Shipping

 

Included

 

    

 

                                       

 

Pa residents add

 

 

 

 

 

 

 

      6% sales tax

 

   _________

 

 

 

                                                               Total      _________

 

Information or Comments:____________________________________________________

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Please mail checks or money orders made payable to: Miles of Memories Photography

Miles of Memories Photography reserves the right to use photographs for display or publication. By signing I hereby grant permission to Miles of Memories Photography to use these images in any and all forms and media.  Regardless of authorization to use photos for publication, the photo copyright remains the property of Miles of Memories Photography.  No duplication or use is permitted without written permission.

Signature:____________________________________________ Date:_____________________
(Parent/legal guardian signature if subject is under 18 years of age)