Customer Contact Information

Please fill out all areas of the form to ensure your request will be processed quickly.

Full Name

Title

Select Mr. Mrs. Ms. Esq. Dr. Sr. Jr.

Street Address

City

State

Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia

Zip Code

Example: 55667-8888

Contact Phone

Example: 1-222-333-4444

Email Address

Example: itsme@youripaddress

Restoration/Correction Service Requested

Type of Service Requested

Select Add Object/Person Beautify Skin of Subject Change Background Correct Color Shift Correct Fading/Yellowing Correct Contrast/Brightness Crop & Reposition Subject/Item(s) Enhance Lighting Enhance Sharpness Fill in Missing Pieces Remove Red Eye Remove Dust Spots Remove Creases/Wrinkles Remove Tears/Scratches/Rips Remove Object/Person

For the above service please provide details to identify the correct object/person in the photograph.

Level of Restoration/Correction Requested (See Guideline Table)

Your Estimate*

Select Minimal Moderate Substantial

Media Details

Type Submitted

Select Original Photograph 35mm Color Negative 35mm Black & White Negative 35mm Color Slide Other Negative Type

No. of Items Submitted

Select Quantity 1 2 3 4 5 to 10 10 to 15 15 to 20 21 & Above

Output File Format

Select BMP EPS GIF JPEG/JPG PNG TIF Photograph 3 x 3 inch Photograph - Wallet Photograph 4 x 6 inch Photograph 5 x 7 inch Photograph 8 x 10 inch

How will you be submitting your photos/files?

Select Order Pre-paid Mailer Send Original Photos in My Packaging Scan Photos & Attach to this form Scan to Floppy Disk/CD & Send in my own packaging

If Attaching your photo(s)/file(s) to this request please upload them here.

Please read our file format information. Attachments are limited to 250 KB per submission

Additional Information/Comments

*Note: Physical evaluation of the photos requiring restoration/correction will determine actual level.