Order Form Please print order form, fill it out, and mail it with your check payable to: Jack P. DeWitt 28 Holiday Drive Norwalk, CT 06851-3403 ======================================================================== Name:________________________________________________________ Street Address:_________________________________________________ City:__________________________State:________Zip:________________ Telephone Number:________________________________ ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Activity Name & Date                   Print #  (*)         Quantity          Price each               Total _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Full payment is due when order is placed                                        Subtotal: ___________                                                                                                                                Mailing:_________$3.00                                                                                                         Amount Due____________    •        The print number will be found in the address line on your web browser. •         It is the four digits after the word Images For Questions, please call me at (203) 846-3345