dr5 write-up    date ___________________    
email: info [at] dr5.com              
Shipping:USPS - dr5FILM . POBOX-580. STUART. IOWA. 50250-0580
Shipping: UPS/FEDEX - dr5FILM . 111 NW 2ND ST. STUART. IOWA. 50250

SERVICE PHONE   515.523.8375       

    
NEUTRAL [DEV-1]           DEV-2 SEPIA - - CALL
QTY________FILM TYPE________________________exposed ISO___________
QTY________FILM
TYPE________________________exposed ISO___________
QTY________FILM
TYPE________________________exposed ISO___________
QTY________FILM
TYPE________________________exposed ISO___________
QTY________FILM
TYPE________________________exposed ISO___________                
 
35mm                120                  220                      4x5 - 8x10              11x14
               SLEEVED-uncut     MOUNTED & BOXED - 35mm   KEEP MY CODES   

ROLL SCANS:     
(35mm + 120)     SMALL    MEDIUM   LARGE
    LF SCAN DIGITAL CONTACTS [ apx.150mg]
DRUM-SCANS     FLATBED-SCANS   (indicate details in :notes")
YES- ok to post one of my photos on social-media
(notes)_______________ _____________________
_____________________ _____________________
_____________________ _____________________
SHIPPING:
   Business address   Residential address   INTERNATIONAL
USPS - DEFAULT
1st-CLASS - 2~5 days         PRIORITY - 2~3 days           EXPRESS
1st-Class w/track
International - to 3 lbs /  Domestic - 13oz         UPS / FEDEX CONTACT US
 or UPS / FEDEX - Account  SHIP number ________________________________________

PHONE & EMAIL ARE REQUIRED.  PLEASE WRITE IT CLEARLY, THANKS.
SHIP AND BILLING ADDRESS ARE THE SAME.

Phone #: _____________________      
EMAIL _________________________________________________

Name & Shipping Address_________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________
PAYMENT:   VISA  . AMEX  - MASTERCARD  . DISC   PAYPAL(APX.5% - fee) 
info@dr5.com
CHECKS-PAYABLE TO dr5  CHECKS MUST INCLUDE RETURN SHIP.
C/C ACCOUNT #________________________________________________________EXP. DATE________

[REQUIRED] CVV2 CODE - 3or4 -digit number on the back of card.______________ [REQUIRED TO PROCESS]

CC BILLING ADDRESS# & ZIP [IF DIFFERENT]_________________________________________
NAME ON CC IF DIFFERENT __________________________________________________________
LIMITATION OF LIABILITY :  No warranties implied. All care is taken to achieve quality results. The limitation warranty
also does not cover any losses or damage that may occur due to an act of nature or shipping. .dr5-chrome will compensate
for any loses on a case by case basis, or loss due to neglect.