The Pix Fix Shop

6 Columbus Av.

Lehigh Acres, FL 33972

In Dade County (305) 790-7223

In Lee County (941) 368-1371

pixfixshop@aol.com

(Please print, fill, and mail with check made payable to: Pix Fix Shop)

Order Form

Last Name: ______________________	First Name: _______________	Middle Initial: ___
Street Address: _____________________________________________		Apt. #: _________
City: ____________________________	State: ___________________	Zip Code: _______
Day Phone: _______________________	Evening Phone: ____________	________
Email: ___________________________	Fax: _____________________

Please write a different ID# on back of each picture

	ID#	Qtty	Price $	Subtotal $
Original reproductions, with touchup	____	______	15.00	________
Change Black&White to Colors	____	______	45.00	________
Additional copies ($7.50 each/ 5 for $30.00)	____	______	______	________
Additional copies ($7.50 each/ 5 for $30.00)	____	______	______	________
Additional copies ($7.50 each/ 5 for $30.00)	____	______	______	________
Additional copies ($7.50 each/ 5 for $30.00)	____	______	______	________
Additional copies ($7.50 each/ 5 for $30.00)	____	______	______	________
Additional copies ($7.50 each/ 5 for $30.00)	____	______	______	________
Shipping and Handling  (Priority mail)				___5.00
		Total:	$	________

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Extensive reconstruction and repair only by estimate !!!!

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Please state special requests and instructions below: