Sharon Smith Talent

SharonSmithTalent.com
Image Scanning Order Form
Please print out this form and include it with your images
when you deliver it to Sharon Smith Talent.

MemberID:

Last Name

First Name

Name:

Address:

Apt./Suite:

City:

State: Zip:

Day Phone:

Eve. Phone:

eMail:

Number of Images to Scan:
	x $15/ea.
SubTotal
TN State Sales Tax (9.25%)
Total
Image Descriptions:

Photographer:
Date Taken:

Please make checks payable to "KineticMedia.com"