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Image Order Form

Use this form to place an order for images in the Dog Show Galleries.  All fields are required.
 
Name
Mailing Address
Address (cont.)
City
State
ZipCode
Country
Day Phone
Eve Phone
Cell Phone
E-mail
Website   - optional
Dog Show 
Dog Show Date - mm/dd/yy
Image Number
Image Number
Image Number
Digital Image Only Yes - $28 per image       No
Digital Image on CD Yes - $15 additional, one-time charge      No
Credit Card Type
Credit Card Number: - 0000-0000-0000-0000

Expiration Date:
Security Code - 3-digit code on back of card

ZipCode of billing address:
   

I authorize Mike Wilkinson Phodography to charge $28 per image and $15 per CD to the credit card listed above.

  I agree       I do not agree

© 2010   Mike Wilkinson