Service Request Form for Photo Retouching

Photo #1   Resize to:                                Special Instructions                          Cost
                   Same as original  _____
                    4 x 6      ______                                                                             $19.00
                    5 x 7      ______
                    8 x 10     ______
                    9 x 12 or larger _______ ($35.00)
                    Number of additional copies (if desired) _____ x $5.00 each =
                    Additional copies of 9 x 12 or larger       _____ x $9.00 each =  _________
Photo #2   Resize to:                                Special Instructions                          Cost
                   Same as original  _____
                    4 x 6      ______                                                                             $19.00
                    5 x 7      ______
                    8 x 10     ______
                    9 x 12 or larger ______ ($35.00)
                     Number of additional copies (if desired) _____ x $5.00 each =
                    Additional copies of 9 x 12 or larger        _____ x $9.00 each =  ________    
                                                                                              Photo Total      ________
                                                                                           
 Use back side for additional photos. 
              If you want your photos returned by Registered Mail, add $13.00   ________                                 
                                                        (For NY residents only) NYS Sales Tax   _________
                                                                                            Grand Total       __________

Name:  _______________________________________________
Shipping Address: ______________________________________
                              _______________________________________
Phone: ________________  Email Address: _____________________________________
Send your check (made payable to Croton Stamp Co.)  or credit card information together with your digital images or photos to: 
PO Box 242, Goshen, NY 10924. Use care in packaging your photos. Reinforce the package properly.
Your originals will be returned to you along with the enhanced photographs. Your satisfaction
is guaranteed or your money back. We reserve the right to return photos that we deem are
beyond our ability to significantly repair or enhance. Use the back of this page for additional
instructions.

Credit card information:

1. Name on card:
2. Credit card type (M/C, Visa, or Discover Card):
3. Credit Card #:
4. Expiration date:
5. Security code #:  this is a 3 digit number found on the reverse side of the card at the far right side of the signature box _______
6. If your credit card billing address is different from your shipping address above, please list it below:   ____________________________________
____________________________________
____________________________________

Croton Stamp Co., PO Box 242, Goshen, NY 10924
Phone (845) 294-7361    
Email: croton@warwick.net