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Please print this form, fill it out and mail with your remittance. Thank you.
Captured Reflections - Print Order Form

 

 

Individual print price ->
$30
$45
Please call
Total in
Dollars
Name of Photograph
8x10
11x14
Larger
         
         
         
         
         
         
         
         
         
    --- GIFT CERTIFICATE ---        
Totals for Quantities and Dollars        
 
 
Michigan residents only please add 6% for sales tax
Grand Total>
Shipping and handling ($13.00 on print orders of 3 or less images)
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please make checks or money orders payable to "Captured Reflections, Inc." All
funds should be in USD (United States Dollars) Once again, thank you for your order.
Note prices above do not include reproduction rights..

 

 

 


 

 

 

 

 

Please include either an E-mail address or a phone number in case there are any questions regarding your order. We will not provide any customer information to any third party sales or marketing organizations.

 

 

*

 

 

 

 

 

 

 

 

Please mail the completed form and payment to:
              Captured Reflections
              PO Box 141
              Milford, Michigan 48381

 

 

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Please Stop here unless you are ordering a Gift Certificate or your order is a gift for another person.

    

For gift certificate or gift orders we will mail the certificate or the print to your address (as specified above) unless you would prefer that we mail the certificate directly to the person receiving the gift. Please provide us with your instructions below:

 

Customer Delivery Information (please print clearly)
First Name  
Last Name  
Street Address #1  
Street Address cont.  
City  
State or Province  
Zip or mail code  
Country  
E-Mail address  
Phone Number*  
Gift Certificate or Gift Instruction Form
(please print clearly)
Name we should enter on the Gift Certificate  
If you would like us to mail the certificate(s) or print(s) directly to the recipient, please provide us their delivery information below, otherwise please leave blank.
First Name  
Last Name  
Street Address #1  
Street Address cont.  
City  
State or Province  
Zip or mail code  
Country  

 

 

 

 

 

 

 

                                                

    

 

For gift certificate orders only, please use the line under "Name of Photograph" in the first section at the top of this page. Please remember to specify the print size and include the sales tax or shipping charges if they are applicable. If you have a message you would like us to include with your gift please be sure to include your message on the back of the printed form. Thanks