NOTE: TURN TIME WILL VARY - DEPENDING ON CINE-VOLUME & REGULAR PROCESSING
dr5 write-up CINE
                date ___________________        
1350 E. WASHINGTON AVE, DES.MOINES, IA, 50316
email: info [at] dr5.com  515.265.1375

DEV-1 NEUTRAL                                   DEV-2 SEPIA [specialty service CALL]

QTY________FILM TYPE________________________exposed ISO___________
QTY________
FILM TYPE________________________exposed ISO___________
QTY________
FILM TYPE________________________exposed ISO___________

CLIP              KEEP MY CODES                 
 
SUPER-8                8mm-DOUBLE                              16mm            
RUN NORMAL     PUSH=PROCESS

(notes)_______________ _____________________
_____________________ _____________________


SHIPPING: Business address           Residential address         INTERNATIONAL
USPS - DEFAULT (1st-CLASS - 2~5 days   /   PRIORITY - 2~3 days   /   UPS-ground - 5-days)
PRIORITY    EXPRESS    1st-Class w/track - International - to 3lbs    /  Domestic - 13oz
UPS -      GROUND         3-day -         2-day -        Overnight-Express 
 or UPS/FEDEX - accnt. (fedex accnt only).  SHIP account #_____________________________________________________



PHONE & EMAIL IS REQUIRED.       PLEASE WRITE IT DOWN CLEARLY.
Phone #: _____________________      EMAIL _______________________________________________________________

Name & Shipping Address
________________________________________________________________   

________________________________________________________
___________________________________________

___________________________________________________________________________________________
PAYMENT:  VISA . AMEX - MASTERCARD . DISCOVER - PAYPAL - info@dr5.com (invoice emailed - -PAYPAL FEE – 3%)
CHECKS-PAYABLE TO:
 dr5  
CHECKS MUST INCLUDE RETURN SHIP. SHORT CHECKS WILL DELAY YOUR ORDER.
NOTE: ORDERS WITHOUT PAYMENT INFO WILL NOT BE PROCESSED AND MAY BE RETURNED UNDONE
          Clients may call in a CC# if that is preferred   -  YOU must call us with this info please.
C/C ACCOUNT #_________________________________________________EXP. DATE____________

[NOW REQUIRED] CVV2 CODE - 3-digit number on the back of card._____________
3% fee will be added for zip/address mismatch
CC BILLING ADDRESS# & ZIP [IF DIFFERENT]______________________________________________________


LIMITATION OF LIABILITY: This process has no warranties. All care is taken to achieve quality resultsThe limitation warranty also
does not cover any losses or damage that may occur due to an act of nature or shipping. dr5-chrome will compensate for any losses on a
case by case basis, or loss due to neglect. dr5-lab reserves the right to refuse services.