Gallery Restoration Order Form
Print this form, fill out and enclose with order
(Attach one Order Form with each photograph)

Sheet # ______ of ______

Customer Information   (Please Print Clearly)

Name:____________________________________

Address 1:________________________________
Address 2:________________________________

City:_____________________________________ 
State:____            Zip:_________

Daytime Phone:_____________________________

Email _________________________________

Total Number of Photographs Sent _______

Please Print Clearly

 Office Use

Date Received:____________________________

Condition:________________________________

Total number of photographs in package _______

Time_____________  Materials_____________
File Name_______________________________

Shipped out:____________________ 
NOTE this must be signed:
I hereby state that I am the owner of the enclosed photograph(s) and no other person or company has ownership or copyrights to these photograph(s).

Signature:  X_______________________________________    Date:_____________
 

Please make the following repairs to my photograph:

 
 

Amount Enclosed: $______________ or bill my    q Visa   q  MasterCard (check one)

Credit Card #:______________________________ Expires:_____________

Name on Card:_____________________________

 

Please wrap your photos in cardboard, clearly mark "Photo Do Not Bend" on the envelope.

Fine Art & Framing Gallery is not responsible for damage or loss during mailing to or from us.

 
 

Shipping Label

 

From:

__________________
__________________
__________________

TO:
Fine Art & Framing Gallery
2723 Murdoch Ave.
Parkersburg, WV  26101

Photo Do Not Bend