B&W write-up / negatives          date _______ email - info [at] dr5.com
1350 E. WASHINGTON AVE, DES.MOINES, IA, 50316
email: info [at] dr5.com  515.265.1375

1) FILM TYPE_________________exp ISO_____________ DEV.NORMAL - push/pull _______
2) FILM TYPE_________________exp ISO_____________ DEV.NORMAL - push/pull _______
3) FILM TYPE_________________exp ISO_____________ DEV.NORMAL - push/pull _______


 35mm          120              220        4X5       5x7        8X10
SPECIAL RUN INSTRUCTIONS:______________________________________________________
__________________________________________________________________________________

Develop only   ROLL SCANS:          DIGITALcontacts 
ROLL SCANS:(35mm + 120) SMALL [5~6mgb]   MEDIUM 10~12mgb]   LARGE [17~19mgb]
X-LARGE [25~30 mgb]    XX-LARGE [35~40mgb]      LF SCAN DIGITAL CONTACTS [ apx.150mg]

SEE THE 'MAIN PROCESSING' PAGE FOR ROLL-SCAN DISCOUNTES @TIME OF PROCESSING.

SHIPPING:   Business address   Residential address   INTERNATIONAL
USPS - DEFAULT
1st-CLASS - 2~5 days        PRIORITY - 2~3 days          EXPRESS
[1st-Class w/track
International - to 3lbs /  Domestic - 13oz]    
 or UPS / FEDEX - Account  SHIP number ________________________________________

PHONE & EMAIL IS REQUIRED.  PLEASE WRITE IT CLEARLY, THANKS.

Phone #: _____________________      
EMAIL ___________________________________________

Name & Shipping Address____________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

PAYMENT:      VISA . AMEX   MASTERCARD . DISC .
PAYPAL [info@dr5.com]

C/C ACCOUNT #_________________________________________________EXP. DATE________

[REQUIRED] CVV2 CODE - 3-digit number on the back of card._________3% fee for zip/address mismatch


CC BILLING ADDRESS# & ZIP [IF DIFFERENT]________________________________________
LIMITATION OF LIABILITY :  No warranties implied. All care is taken to achieve quality results.The 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 loses on a case by case basis, or loss due to neglect.