ORDER FORM

For you convenience, this order form may be printed, filled out, and submitted along with check or money order for the appropriate amount.   Please make checks and money orders payable to:

David W. Zimmerly
344 Lakewood Rd., RR3
Perth, ON,  K7H 3C5
Canada

 

Photographs

Title

Description

(e.g., Rajasthan, India, 2004

Print Size

Matte Size

Quantity

Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                                        Please add Shipping & Handling:           ________

                                                                                                                                                 TOTAL:           ________       

Ship to: your name, address, zip or postal code, e-mail address

___________________________________________

___________________________________________

___________________________________________

___________________________________________

Date Received: ______________________

Date Sent:        ______________________