Please print this form and mail to us

SLONINA PHOTOGRAPHY  (web)

PO BOX 162.  North Grafton, MA 01536

Email: Sloninawebsite@aol.com      Phone: (508) 839-5111

Your Name: _____________________________                Date:____________

Street Address: ____________________________________________

Town, State, and Zip Code: _______________________________________

Email Address (If any): ________________________________________

Phone Number (If any questions related to order): _____________________

Item(s): If more than 6 different items please continue on back

Picture #    Description: (include mat color)                               Size      Quantity    Price

__________ ____________________________________ ______ ________ ______

__________ ____________________________________ ______ ________ ______

__________ ____________________________________ ______ ________ ______

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Type of Credit Card (please circle) : VISA  MASTERCARD   AMERICAN EXPRESS   DISCOVER

Credit Card Number: ______________________________________

Expiration Date: _______________________________________

Signature (as it appears on card): ____________________________

If you are paying by check please make payable to Slonina Photography

Do you want to be added to our mailing list (please circle)?:    YES    NO