MyPhotoRx Order Form

(A Service Provided by MyDataRx.Com, Inc.)

Please print out two copies of this form and send one with your pictures/slides and keep one for your records. If you have any questions or special requests, feel free to call us at (574) 633-4036.
Per Image Price
Paper Photos up to 8 x 10 300 dpi - $0.45    QTY ______ 600 dpi - $0.65    QTY______
Paper Photos in Albums

300 dpi - $0.69    QTY ______ 600 dpi - $0.89    QTY ______
35mm Slides 2000 dpi - $0.59  QTY ______ 4000 dpi - $0.65  QTY ______
35mm Negatives 2000 dpi - $0.99  QTY ______ 4000 dpi - $0.95  QTY ______

Other Options
Printed Thumbnail Album $1.00 per page (min.$5.00) QTY ______

Preload Kodak Digital Picture Frame (frame included in price)
  8" Picture Frame $169.95  QTY ______
10" Picture Frame $219.95  QTY ______

DVD Slideshow Setup Fee
$39.95**  QTY ______
** Digital pictures provided can be added to a slide show for $0.15 per picture.
**Music can be added for $1.75 per song (estimated approximately 1 song for every 25 images).
**DVD label made from photo of your choice with title.
**Be sure to include music selection, photo choice for label and title with your order.

Scan Birth Announcements, Graduation Programs, etc.
per page $0.54*  QTY ______        *Newspaper clippings additonal cost, please call for price.

Document Scanning Service
per image $0.45  QTY ______      Image save to a PDF format (page size 8.5 x 11 single sided).

Pick up and delivery Service
$15.00   For St. Joseph, Marshall, and La Porte counties in Indiana.

Extra CDs or DVDs
CDs $8.95  QTY ______      DVDs $10.95  QTY ______

Special Package Package # ______     QTY _____

Name: __________________________________ Phone/Contact#: ___________________________
Address: ___________________________________________________________________________
City, State, Zip code: __________________________________________________________________
E-mail: _________________________________________
COMMENTS: _______________________________________________________________________
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