Lebanon Reporter

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May 23, 2006

Photography and Lamination Form

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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