2805 Wooded Creek Drive  Columbia, MO. 65203 (573) 446-4493   

Event Name: __________________________________ Event Date: ___________________
Order Line Photo Id Qty Circle Desired Size
(select only one size per order line)		 Price
1     4 Wallets     4x5    5x5    5x7    8x10    11x14    16x20  
2     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
3     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
4     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
5     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
6     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
7     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
8     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
9     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
10     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
11     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
12     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
13     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
14     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  
15     4 Wallets    4x5    5x5    5x7    8x10    11x14    16x20  

4 Wallets: $8    4x5: $10    5x5: $14    5x7: $14    8x10: $20    11x14: $80    16x20: $120
Missouri sales tax will will be added @ 7.55%    Shipping: $10 to $25 depending on location
Ship to Name: ______________________________________
Your Daytime Phone: ___________________
Ship to Address: __________________________________________________________________________
City: ___________________________________ State: __________________   Zip:______________

Payment Method: (circle one)
Check        M/C        Visa     
CC Number: ________ - ________-________-________
Name on CC: ________________________________________
Exp Date: (MM/YYYY): ______________

Signature: __________________________________________________


Please mail this order form to: Michael Pritchett Photography.    Thank you for your order!