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Photo Order Form

To order publication quality copies of images featured in the catalog, print out and fax the signed and completed order form along with proper payment to RMS-Republic.com.   A copy of this order form will be sent to you with your order; the original will be retained on file at RMS-Republic.com. Please note: Not all printers are alike. This form may print out on 2 pages. Please be sure both are completed before you send your form.

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Ordered by: Name: _____________________________________ Business: _________________________________ Address: __________________________________ City: _______________ State: ___ Zip: _____ Phone: ______________ Fax: ________________ E-mail:____________________________________ This order should be fulfilled as follows (check one): __ Images have already been downloaded. No further response is necessary; __ Please provide URL for high resolution zipped .PCD file download; __ Please ship photo CD to the above address.

Office Use: Ref #: _____________ Staff: _____________

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Photo Album	Page Number, Row, Column	Caption/Description	Price (See "Photographic Fee Schedule".)
|1|_______________ | |2|_______________ | |3|_______________ | |4|_______________ | |5|_______________ |	Pg___Row___Col___ | Pg___Row___Col___ | Pg___Row___Col___ | Pg___Row___Col___ | Pg___Row___Col___ |	__________________ | __________________ | __________________ | __________________ | __________________ |	________ ________ ________ ________ ________

Photograph(s) to be used for: __ Print publication __ Film/Video __ Digital Publication __ Display/Exhibit __ Advertising __ Presentation __ Commercial __ Research/Personal/Not for Publication	Subtotal $_____________ Delivery in NY, add 8.375% Sales Tax, or Provide Tax Exempt Number Here: ____________ Overnight Delivery Add $25, or Provide Shipping Account Number Here: ____________ Total ____________
Please describe photograph use checked above: _____________________________________ _________________________________________________________________________________

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Method of Payment (payment must be made in U.S. dollars drawn on a U.S. bank)
Payment in full is required before photographs will be delivered:

Credit Card Number: _________|_________|_________|________   Expiration Date ___|___

__ Please charge to my:  VISA   MasterCard   Discover    American Express
__ Check or Money Order made payable to "MVSHQ, Inc."
__ Qchex or PayPal to billing@rms-republic.com

Method of Delivery:

__ Download   __ Pick up   __ U.S.1st Class Mail   Ship Via_________ Account # ________________                    

The CONDITIONS of this form are approved and agreed to by:
Requester's Signature:  X____________________________________  Date: ________
Use Authorized by:  ________________________________________  Date: ________
[ RMS-Republic.com Representative ]