Private Purchase Order Form ( Photos ).

Date:  __________________________________

First Name: ______________________ Last Name: _________________________________________

Address: ________________________________________________  City: ______________________

State / Province: __________________  Zip / Post Code: __________  Country: _____________________

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

E-mail: __________________________________________ Other: _________ ____________________

Images description or Numbers: __________________________________________________________

__________________________________________________________________________________

Total Number of Images: _________ Total Amount: $ __________ in US.   Prepaid shipment: $___________

The amount must be approved with sales or operations (enter the approval code) :  _____________________ 

Your Method of Payment:               No COD's. 

Type of Credit Card : ___________ Holder's full name : ________________________________________

Card number : _____________________________________________  Exp. date : ________________

Western Union - Money transfer control number : ______________________________________________ 

Money Order by :_____________________________________________________________________ 

Entry details: ________________________________________________________________________

For personal use only: 

I understand that the images are copyright protected, and without FPINS.,  FEI., or photographer's  
written permission cannot be used for publishing or commercial usage. 

 _________________________________________________________________________
Signature                                                           Date:                                       In:      

Fill out the order form with all details, sign and e-mail to: FEI - Photos
To confirm your shipment or order call: (705) 745-5770 or by