Commercial Purchase Order Form ( Art ).

Date: ________________________  Client or Subscriber Number:  _____________________________________

New request: ___________________________ Deadline date / _______________time/____________

First Name: _______________________ Last Name: _______________________________________

Company Name: ___________________________________________________________________

Address: ____________________________________________ City: _________________________

State / Province: ______________ Zip / Post Code: _______________ Country: ___________________

Phone No: ( ____ ) ________________________ Fax No: ( _____ ) __________________________

E-mail: ___________________________________________ Other: __________________________

________________________________________________________________________________

Preferred downloads: ____________________________ Prints: ______________________________

Medium High-Res. Scan: ( _____________________ Meg ) CD: ______________________________

Usage Type:

Advertising: ______________ Textbook: _______________ Brochure: ___________ Editorial: ________

A/V: _____________________ Electronic: ___________________ Corporate/Industrial:______________

Other specify:_______________________________________________________________________

Size:1/4 Page:______ 1/2 Page:_______ Full Page:_______ Cover: ________

Other:_____________________________________________________________________________

Distribution:

Local:________ Regional: _______ National: ______ International:_________

Specify Area: _______________________________________________________________________

Rights:  One-Time Use:____________________________ Other: _______________________________

Print Run:__________________ Length of Time: _______________________

Has Image Been Used in a Computer?                        Yes:  ____ No: ___

Is a Fax of Layout Herewith?                                              Yes: ____ No: ___

Will a Credit Line be Used?                                                Yes: ____ No: ___

Method of Payment:

Type of Credit Card : ___________ Holder full name : ________________________________________

Card number : ____________________________________  Exp. date : ________________________

Western Union - Money transfer control number : _____________________________________________ 

Money Order by : ____________________________________________________________________ 

Entry details: _______________________________________________________________________

Art description or Numbers: _________________________________________________________

_________________________________________________________________________________

Total Number of Images:______________ Total Amount: $________ Prepaid shipment: $_______

Signature:_____________________________________ Date:_________ In: ____________________

Fill out the Order Form with all details, signed and e-mail to: FEI - Art
To confirm your shipment or order call: (705) 745-5770