Jenestar Web Creations, LLC - custom screen savers order form

Jenestar Web Creations
Personal Custom Screen Saver Order Form

(Use Your Browser's Print Button to Print This Form)


Name: .....................................................
Address: ..................................................
City: ....................... State: .......Zip:...........
E-Mail: ........................... Telephone: ............

Number of photos enclosed: ......

I would like a preview copy delivered electronically:
..... YES  .....NO        

Please number each of your photos lightly in pencil on the back
in the order you want them displayed. Add a caption for each photo 
if desired.

Photo 1 ........................ Photo 6 ............................
Photo 2 ........................ Photo 7 ............................ 
Photo 3 ........................ Photo 8 ............................ 
Photo 4 ........................ Photo 9 ............................ 	
Photo 5 ........................ Photo 10 ........................... 

Text for Introductory Screen:
.....................................................................
.....................................................................
.....................................................................

Choose a Name for Your Screen Saver: 
..................................................(ex. Mary's Wedding)

ITEM QUANTITY COST TOTAL

Custom Screen Saver 1 29.95 29.95

Additional Photos in Screen Saver 2.50

Additional Copies of Screen Saver
(must be ordered at same time) 5.00

Shipping & Handling 4.50 4.50

TOTAL ORDER $

ITEM	QUANTITY	COST	TOTAL
Custom Screen Saver	1	29.95	29.95
Additional Photos in Screen Saver		2.50
Additional Copies of Screen Saver (must be ordered at same time)		5.00
Shipping & Handling	4.50	4.50
TOTAL ORDER	$

Mail photographs, order form, and check or money order to:
Jenestar Web Creations, LLC
PO Box 17057
Smithfield, RI 02917
PLEASE ALLOW 1-2 WEEKS DELIVERY - THANK YOU FOR YOUR ORDER

Return to Custom Screen Savers