Photography and Lamination Form

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May 23, 2006

Anonymous The Lebanon Reporter Tue May 23, 2006, 09:50 AM EDT

Date of Order: * required field

Name:* required field

Address: * required field

   City: * required field

   State: * required field

   Zip:* required field

Daytime Telephone:* required field

Issue Date: * required field

Page No:* required field

Description of Photo or Reprint Item:* required field

Black & White Photo Reprint:
One 8 x 10 = $10	$
One 5 x 7 = $5	$
Color Photo Reprint:
One 8 x 10 = $20	$
One 5 x 7 = $10	$
Lamination Reprints
One color lamination = $5	$

Total Amount of Order	$

Photos may not be reprinted without express written permission of the Lebanon Reporter and the Times Sentinel.

By submitting my information via this form, I authorize an associate

of this newspaper to contact me regarding payment.

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Lebanon, IN 46052

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