http://media.mgnetwork.com/pow/docs/rsn_photo_req

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All copyrights are owned by Richmond Suburban Newspapers, a Media General Company. No duplication of photos, electronic or otherwise, is allowed. All photos are for personal use only; any commercial usage requires permission from the publisher. For information on commercial/publication permission, contact the office.

Photo Order / Receipt

804-379-6451

804-556-3135

804-746-1235

804-598-4305

PO Box 420 Midlothian, VA 23113

PO Box 139 Goochland, Va 23063

PO Box 1118 Mechanicsville, VA 23111

PO Box 10 Powhatan, VA 23139

Name:

Date:

Phone number: Mailing Address:

(Street) (City/State/Zip Code)

Fill in as applicable: Online or In Print:

Name of Gallery / Slideshow or Date of Publication:

Photo # or Page #: (And a description if needed)

Sizes Available:

Photographer Initials

Pd:

Cash:

Check #:

Receipt Book #:

Quantity:

4x6 ($10), 5x7 ($12), 8x10 ($15)

Payment: (prepayment is required) Total:

Size:

Received by:

Thank you for your order! Please contact the office if you have any questions, comments, or requests.



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