PANORAMIC PRINT ORDER FORM

(From your browser please fill out this form, print and return it to us via regular mail as described on the previous page.)

Billing & Shipping Address
Your Name
Street Address
City
State
(must be same as credit card billing) Zip Code
Phone
E-Mail (optional)

Print Information
Image Name
Gallery Name
Matte, Glossy or Giclee
Print Size

Please print the form then fill out the information below by hand.

Print Cost: ____________

(CO residents only) Tax 7.4%: __________

Flat Rate Shipping (US & Canada only): $4.95

Total: _________________

MasterCard or Visa  (circle one)

Card #: ____________ - ____________ - ____________ - ____________

Expiration Date: Month: _________  Year: __________

 MasterCard and Visa