Film Order Form

1 COLOR PRINT FILMF ujicolor 35mm - 24 exp (200 speed)Kodak Gold - 36 exp (200 speed)Kodak Ektar 120 (100 speed)Fujicolor 35mm - 24 exp (400 speed)FUJICHROME E6 SLIDE FILMF ujichrome 35mm Provia RDPIII 100F - 36 exp (single roll unboxed)Fujichrome 120 Provia RDPIII 100 FFujichrome 35mm Velvia RVP ASA 50 OR 100 (Circle) - 36 exp (single roll unboxed)MOVIE FILMW ittnerchrome 200D Regular 8 X 25ft E-6 Process ASA 200 Daylight (for double 8 cameras) (NEW)Wittnerchrome 200D Super 8 50ftWittnerchrome 200D 16mm 100ft $ $ $ $ $ $ $ PRICEQUANTITYTOTALCOMPANYNew film Order FormDwayne s Box 274, Parsons, KS 67357ship to:415 S. 32nd St. (FedEx or UPS)Parsons, KS 67357phone:800-522-3940or620-421-3940go to: to:CHECK OR MONEY ORDERPAY PAL (REQUIRES VALID EMAIL) >WE DO NOT ACCEPT AMEX<ZIPCODE3 DIGIT CVS (ON CARD BACK)BILLINGADDRESSEXPIRATIONCREDIT CARDSELECT PRINT FINISH FOR THIS ORDERKS Residents add Sales TaxORDER TOTAL >Limit of Liability: Submitting any film or negative to this firm for processing or other handling constitutes an agreement by you that any damages or loss by our company, subsidiaries, or agents, even though due to the negligence or other fault of our company, subsidiaries, or agents, will only entitle you to a replacement with a like amount of unexposed film or processing.

2 Except for such replacement, the acceptance of the film or negative is without other warranty or liability, and recovery for any incidental or consequential damages is excluded. Dwayne s Photo is not responsible for any loss, damage or delay caused by the Postal Service, UPS, FedEx, or any other package carrier. Prices and terms are subject to change without : December 2017 INTERNATIONAL SHIPPING > OUTSIDE THE VIA POSTAL SERVICE PRIORITY MAIL INTERNATIONALC anada and Mexico - for 1 to 10 rolls or up to 4 pounds All other countries - for 1 to 10 rolls or up to 4 poundsInternational Postal shipped Order larger than 10 rolls or over 4 pounds will incur additional charges. You may call or email for a shipping estimate. International orders may incur a customs fee.

3 It is customer s responsibility to pay customs and import duties.$ $ & HANDLING CHARGES > INSIDE THE U. Shipping USPS - First RollStandard Shipping USPS - Each Add l RollFedEx Ground - First RollFedEx Ground - Each Add l Roll$ $ $ $ : This form is to purchase new film only. There are seperate forms for film processing. COUNTRYNAMEADDRESSCITYPOSTAL CODE ZIPPHONEE-MAILSTATEOR PROVINCE$ $ $ & WHITE PRINT FILMFuji Neopan 35mm - 36 exp (100 speed)Fuji Neopan 120 Acros (100 speed)$ TMAX 120 (400 speed) OR TMAX 120 (100 speed) (Circle)$ $ $ $ Overnight - First RollFedEx Overnight - Each Add l Roll