Dwayne’s Photo New Film Order Form mail to: P.O. Box 274, Parsons, KS 67357 COMPANY ship to: 415 S. 32nd St. (FedEx or UPS) NAME Parsons, KS 67357 ADDRESS phone: or STATE 800-522-3940 620-421-3940 CITY OR PROVINCE go to: www.dwaynesphoto.com POSTAL CODE ZIP COUNTRY SELECT PRINT FINISH FOR THIS ORDER PHONE E-MAIL CHECK OR MONEY ORDER PAY PAL (REQUIRES VALID EMAIL) >WE DO NOT ACCEPT AMEX<

CREDIT CARD

EXPIRATION 3 DIGIT CVS (ON CARD BACK) Note: This form is to purchase new film only. BILLING ZIP There are seperate forms for film processing. ADDRESS CODE

COLOR PRINT FILM UNIT PRICE QUANTITY TOTAL Fujicolor 35mm - 24 exp (200 speed) $3.25 Gold - 36 exp (200 speed) $5.29 Kodak Ektar 120 (100 speed) $5.45 Fujicolor 35mm - 24 exp (400 speed) $3.75 FUJICHROME E6 SLIDE FILM Fujichrome 35mm RDPIII 100F - 36 exp (single roll unboxed) $10.99 Fujichrome 120 Provia RDPIII 100F $8.25 Fujichrome 35mm RVP ASA 50 OR 100 (Circle) - 36 exp (single roll unboxed) $12.75 MOVIE FILM Wittnerchrome 200D Regular 8 X 25ft E-6 Process ASA 200 Daylight (for double 8 cameras) (NEW) $43.00 Wittnerchrome 200D Super 8 50ft $43.00 Wittnerchrome 200D 16mm 100ft $61.00 BLACK & WHITE PRINT FILM Fuji 35mm - 36 exp (100 speed) $6.99 Fuji Neopan 120 Acros (100 speed) $5.79 Kodak TMAX 120 (400 speed) OR TMAX 120 (100 speed) (Circle) $5.99 SHIPPING & HANDLING CHARGES > INSIDE THE U. S. Standard Shipping USPS - First Roll $5.00 Standard Shipping USPS - Each Add’l Roll $0.50 FedEx Ground - First Roll $11.00 FedEx Ground - Each Add’l Roll $0.50 FedEx Overnight - First Roll $25.00 FedEx Overnight - Each Add’l Roll $1.50 INTERNATIONAL SHIPPING > OUTSIDE THE U.S. VIA POSTAL SERVICE PRIORITY MAIL INTERNATIONAL Canada and Mexico - for 1 to 10 rolls or up to 4 pounds $25.00 All other countries - for 1 to 10 rolls or up to 4 pounds $34.00 International Postal shipped order larger than 10 rolls or over 4 pounds will incur additional charges. You may call or email for a shipping estimate. International orders may incur a customs fee. It is customer’s responsibility to pay customs and import duties. Limit of Liability: Submitting any film or negative to this firm for processing or other handling constitutes an agreement by you that any damages KS Residents add 9.25% Sales Tax or loss by our company, subsidiaries, or agents, even though due to the negligence or other fault of our company, subsidiaries, or agents, will only entitle you to a replacement with a like amount of unexposed film or processing. Except for such replacement, the acceptance of the film or negative is without other warranty or liability, and recovery for any incidental or consequential damages is excluded. Dwayne’s Photo is not responsible for any loss, damage or delay caused by the U.S. Postal Service, UPS, FedEx, or any other package carrier. Prices and terms are ORDER TOTAL > subject to change without notice. REV: December 2017