*Last Name:  

       *Organization:  

  Street address:  

               *City:  

  State/Province:  

            Zip code:  

        *Country:  

              *Phone:  

            *Fax:  

 *Seaport or Airport

  to deliver 

         *E-mail:  

 Manufacturer   

 Speed of film  

 # of exposures 

 Size of film   

    # of Rolls    

 Kodak          

 Fuji           

 Konica         

 Generic        

                  *Is USD financing approved?      

  *How soon will you purchase selected items?      

                                 If 'specify'