ORDERFORM FOR EZSCAN.COM PRODUCTS & SERVICES (v.01)
Print this order form, and send with all photos/items and payment to:

EZSCAN.COM
P.O. BOX 391
CEDARHURST, NY 11516

-----------PLEASE BE SURE THAT YOU HAVE READ, AND AGREED TO OUR DISCLAIMER!->

**YOUR E-MAIL ADDRESS: _______________________   (MUST ANSWER ALL ITEMS W/ **)

**YOUR FIRST & LAST NAME:__________________________  **TODAY'S DATE:_________

**STREET ADDRESS:______________________________  **CITY:_____________________

**STATE:_________  **ZIP:_________  **HOME PHONE NUMBER:_____________________


EZSCAN.COM RESPECTS YOUR PRIVACY!  THE E-MAIL ADDRESS IS NEEDED TO SEND YOU YOUR
IMAGES.  YOUR NAME & ADDRESS INFORMATION IS NEEDED TO VERIFY PAYMENT, IF SENDING
A PERSONAL CHECK, AND IS ALSO USED AS A SHIPPING ADDRESS FOR CERTAIN PRODUCTS.


**SERVICE REQUESTED: (REGULAR OR OCR SCAN?) __________    **QUANTITY: _______

         PHOTOCD QTY: _____  PHOTODISK QTY: _____  PHOTOCOMPOSITE QTY: ______


PLEASE DESCRIBE ANY INSTRUCTIONS FOR PHOTO CROPING, PHOTO FRAMING, TEXT ADDITION,
PHOTO COMPOSITES, OR ANY OTHER INSTRUCTIONS/DETAILS: (INCLUDING COLORS, STYLES,
SIZES, ETC.) - EXPLAIN WHAT YOU WOULD LIKE DONE! (If you need more room to write,
continue on back of paper.)
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PLEASE CHECK THE EZSCAN.COM WEBSITE FOR LATEST PRICES & DISCOUNTS TO ENSURE THAT
YOU INCLUDE SUFFICENT PAYMENT!  -  IF YOU WOULD LIKE YOUR PHOTOS RETURNED, BE SURE
TO INCLUDE A S.A.S.E WITH YOUR ORDER.  UPON RECEIVING YOUR ORDERFORM, YOU SHOULD
RECEIVE AN E-MAIL WITHIN ONE BUSINESS DAY.

**TOTAL PAYMENT ENCLOSED: ____________  **ARE YOU A PREVIOUS CUSTOMER?: ________

**ONCE AGAIN, PLEASE WRITE YOUR E-MAIL ADDRESS: ________________________________

FINALLY, MAY WE ASK WHERE YOU HEARD OF US?: ____________________________________
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THANK YOU FOR YOUR BUSINESS.  WE LOOK FORWARD TO SERVING YOU NOW, AND IN THE FUTURE!