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<h6>Fill Out this Form
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and Mail to:  Miller Printing Studio<br>
6245 Goodwin Road<br>
Pinson, AL 35126<br><br></h6>
<font size=1>(205) 681-6699<br>
9 a.m. - 3:30 p.m. C.S.T., M-F<br>
email:  info@MillerPrints.com<br>
www.MillerPrints.com</font></center>
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May we use your photo in a sample on the web site?<INPUT TYPE="radio" NAME="UsePhoto?" VALUE="Yes"><font size=1>Yes</font> &nbsp; <INPUT TYPE="radio" NAME="UsePhoto?" VALUE="No"><font size=1>No</font>
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<td width="25%">
<font size=1><b>Description and Price</b><br>
<table>
<tr>
<td align=left valign=top width="25%">
<table border=1>
<tr>
<th colspan=2 align="center"><font size=1>Collage Prints & Frames</font></th>
<tr>
<th align="left" width="66%"><font size=1>SIZE</font></tH>
<th align="left" width="33%"><font size=1>PRICE</font></tH>
</tr>
<tr>
<td width="66%"><font size=1>8½ by 11</font></td>
<td width="33%"><font size=1>$30.00</font></td>
</tr>
<TR>
<td width="66%"><font size=1>8½ by 11 Additional Prints</font></td>
<td width="33%"><font size=1>$10.00</font></td>
</TR>
<tr>
<td width="66%"><font size=1>8½ by 11 Framed</font></td>
<td width="33%"><font size=1>$50.00</font></td>
</tr>
<TR>
<td width="66%"><font size=1>11 by 14</font></td>
<td width="33%"><font size=1>$45.00</font></td>
</TR>
<TR>
<td width="66%"><font size=1>11 by 14 Additional Prints</font></td>
<td width="33%"><font size=1>$15.00</font></td>
</TR>
<TR>
<td width="66%"><font size=1>11 by 14 Framed</font></td>
<td width="33%"><font size=1>$65.00</font></td>
</TR>
</table>
</td>
<td align=left valign=top width="75%">
<font size=1>
Our collage prints are printed on heavy weight professional photo glossy paper.  They are suitable for framing and make great gifts. The <b>8½ by 11</b> fits in most document frames and the <b>11 by 14</b> is another popular frame size if you wish to frame them yourself.  We also offer them already framed for your convenience.  You may have 1 to 12 photos, text and any additional graphics of your choosing printed on your collage. We can tailor it to correspond with any theme i.e. birthday, graduation, wedding et cetera.  Our logo is the only thing printed on the back of the collage.  All photos are returned with your finished order.<br><br>
<b>Customer Agreement</b><br>
By sending a photograph(s) to Miller Printing Studio, customer decrees/warrants that he/she owns the rights to the photo(s) and has the authority to give MillerPrints permission to reproduce from the photo(s) enclosed.  Customer will send a <a href="javascript:diagram('/releaseform.htm')">release</a> from the photographer for any professionally taken photos enclosed.
</font>
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<TR>
<th width="11%" align=left valign=bottom>
<FONT SIZE=1>SAMPLE #</Font>
</th>
<th width="49%" align=left valign=bottom>
<FONT SIZE=1>DESCRIPTION</Font>
</th>
</TH>
<TH WIDTH="10%" valign=bottom>
<FONT SIZE=1>QTY</Font>
</TH>
<TH WIDTH="10%" valign=bottom>
<FONT SIZE=1>PRICE</Font>
</TH>
<TH WIDTH="10%" valign=bottom>
<FONT SIZE=1>TOTAL</Font>
</TH>
</TR>
<TR>
<TD align=center>
<INPUT TYPE="text" NAME="Sample1" SIZE="12" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="12">
<hr width="100%" size=1 align=right noshade>
<INPUT TYPE="text" NAME="Sample2" SIZE="12" VALUE="More Prints?" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="12">
</TD>
<TD align=left>
<SELECT NAME="Description1" SIZE="1">
<OPTION>8½ by 11 Collage Print
<OPTION>11 by 14 Collage Print
<OPTION>8½ by 11 in Frame
<option>11 by 14 in Frame

</SELECT>
<hr width="100%" size=1 align=right noshade>
<INPUT TYPE="text" NAME="Description2" VALUE="More Prints of Above" SIZE="55" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="55">

</TD>
<TD align=center>
<INPUT TYPE="text" NAME="Quanity1" SIZE="12" VALUE="First" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="15">
<hr width="100%" size=1 align=right noshade>
<INPUT TYPE="text" NAME="Quanity2" SIZE="12" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="15">
</TD>
<TD align=left VALIGN=middle>
<SELECT NAME="Price" SIZE="1">
<OPTION>$30.00
<OPTION>$45.00
<OPTION>$50.00
<OPTION>$65.00</SELECT>
<hr width="100%" size=1 align=right noshade>
<SELECT NAME="Price2" SIZE="1">
<OPTION>$10.00
<OPTION>$15.00</SELECT>
</TD>
<TD align=center valign=bottom>
<SELECT NAME="Total1" SIZE="1">
<OPTION>$30.00
<OPTION>$45.00
<OPTION>$50.00
<OPTION>$65.00</SELECT>
<hr width="100%" size=1 align=right noshade>
<INPUT TYPE="text" NAME="Total2" SIZE="10" VALUE="$" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="10">
</TD>
</TR>
<tr>
<td colspan="3" align=left>
<FONT size=1><b>Proof:</b> Optional $2.00</FONT><BR>
<INPUT TYPE="radio" NAME="Proof?" VALUE="Yes, email it to me"><FONT size=1>Yes, email it to me  <INPUT TYPE="radio" NAME="Proof?" VALUE="Yes, post it on the web site">Yes, post it on the <a href="javascript:diagram('/proofs.htm')">proofs page</a> for me</FONT><BR> <INPUT TYPE="radio" NAME="Proof?" VALUE="No, just process this order to expedite shipment"><FONT size=1>No, just process this
      order to expedite shipment</FONT>
</td>
<td align=left valign=bottom>
<font size=1> &nbsp;&nbsp;$2.00</font>
</td>
<td align=center valign=bottom>
<INPUT TYPE="text" NAME="ProofPrice" SIZE="10" VALUE="$" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="10">
</td>
</tr>
<tr>
<td colspan=4 align=left valign=bottom>
<table width="100%">
<tr>
<td align=left VALIGN=TOP><font size=1><b>Alabama resident:</b> add 6% sales tax</font></td><td align=right VALIGN=TOP><a href="javascript:diagram('/calculator.htm')"><font face="verdan,arial" size=1><u>Click for Calculator</u></font></a></td></tr></table>

</td>
<td align=center valign=bottom>
<INPUT TYPE="text" NAME="Tax" SIZE="10" VALUE="$" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="10">
</td>
</tr>
<tr>
<td colspan=2 align=left valign=bottom>
<font size=1><b>Card Information Front/Inside</b>
<TEXTAREA name=CardInfo rows=5 cols=40>For internet Orders. Give all special instructions, front and inside wording here.</TEXTAREA>
</td>

<td colspan="2" align=left valign=top>

<font size=1><b>S &amp; H Charges:</b> Required</font>

<table border="1" width="100%">
<tr>
<td width="50%"><font size=1>1 to 10 Collages</font></td>
<td width="50%"><font size=1>$11.50</font></td>
</tr>
<tr>
<td width="50%"><font size=1>11 to 25 Collages</font></td>
<td width="50%"><font size=1>$13.30</font></td>
</tr>
<tr>
<td width="50%"><font size=1>26 to ?</font></td>
<td width="50%"><font size=1>FREE</font></td>
</tr>
</table>
</td>
<td align=center valign=bottom>
<INPUT TYPE="text" NAME="S &amp; H" SIZE="10" VALUE="$" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="10">
</td>
</tr>
<tr>
<td colspan=4 align=left valign=bottom>
<table width="100%">
<tr>
<td width="75%">
<font size=1><b>Total: </b>For mail order, make FULL payment by check payable to Miller Printing Studio.<br>(Returned check charge is $30)<br>
or provide credit card information below<br><br>
Amex|MC|Visa|Discover #  ________________________________ exp ______ / ______<br><br>
Signature:  ___________________________________________________</font>
</td>
<td width="25%" align=right valign=bottom>
<INPUT TYPE="hidden" NAME="end_display" VALUE="/confirm.htm">
<INPUT TYPE="hidden" NAME="order" VALUE="Name, Address, City, State, Zip, Phone, Time, Email, UsePhoto?, Sample1, Description1, Quanity1, Total1, Sample2, Description2, Quanity2, Total2, Proof?, ProofPrice, Tax, S&amp;H, CardInfo, GrandTotal">
<font size=1>
If ordering via internet, click the "Order Now" button below and payment may be made on the next page.<br><br><INPUT type=image src="/submit.gif" alt="send your order via email"
name=xbutton> 
</td>
</tr>
</table>
</td>
<td align=center valign=bottom>
<INPUT TYPE="text" NAME="GrandTotal" SIZE="10" VALUE="$" style="BORDER-RIGHT: #ffffff 0px solid; BORDER-TOP: #ffffff 0px solid; font size: 11px; BACKGROUND: #ffffff; BORDER-LEFT: #ffffff 0px solid; COLOR: #333333; BORDER-BOTTOM: #ffffff 0px solid" MAXLENGTH="10">
</form></td>
</tr>
</table>
<center>
<FONT size=1>For mail orders, please use the back of this order form, a separate sheet of paper, and/or write on the back of each photo to provide us with your wording, placement of photographs, text and graphics.  Be specific as to which color or photo should be the background and where you want photo(s) and text to be placed.  Click <a href="/wording.htm" TARGET="_BLANK"><b><u>HERE</u></b></a> for card wording suggestions.<br><b>Thank you for choosing <a href="http://www.millerprints.com">Miller Printing Studio</a> to help you share your memories.</b>
</FONT>
</CENTER>
</TD>
</TR>
</TBODY>
</TABLE>
</CENTER>
</font>
</body>
</HTML>