.dr5-lab    C-41 write-up      date __________     RUSH
111 NW 2ND ST, STUART, IA, 50250
email: info [at] dr5.com  515.265.1375                LAB RATES HERE  
1) FILM TYPE____________________________________ No.of rolls ______
2) FILM TYPE____________________________________ No.of rolls ______
3) FILM TYPE____________________________________ No.of rolls______
4) FILM TYPE____________________________________ No.of rolls______


KEEP MY CODES                 
 
35mm           120            220           4x5 - 5x7 - 8x10    

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.
                 
 NOTES_____________________ _______________
_____________________ _____________________

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.