<form method="POST" Action="/_ihnextras/cgi/cgishell.exe?REPLYTOVENDOR">
<input type="hidden" name="Recipient" value="eaporders@eapphoto.com">
<input type="hidden" name="redirect" value="http://www.eapphoto.com/eap_web_107.htm"
<pre>
<b><u>Customer Information</u></b>
First Name: <input type="text" name="req-First Name" size="10"> Last Name: <input type="text" name="req- Last Name" size="20">
Street Address: <input type="text" name="req-Street Address" size="30">
Suite / Apt. #: <input type="text" name="Suite / Apt. #" size="10">
City: <input type="text" name="req-City" size="15"> State: <Select Name="State" Size="1"><Option selected>Select<Option>AL<Option>AK<Option>AS<Option>AR<Option>AZ<Option>CA<Option>CO <Option>CT<Option>DE<Option>DC<Option>FL<Option>FM<Option>GA<Option>GU<Option>HI<Option>ID<Option>IL<Option>IN<Option>IA<Option>KS<Option>KY<Option>LA<Option>ME<Option>MH <Option>MA<Option>MD<Option>MI<Option>MN<Option>MS<Option>MO<Option>MT<Option>NE <Option>NV<Option>NH<Option>NJ<Option>NM<Option>NY<Option>NC<Option>ND<Option>MP <Option>OH<Option>OK<Option>OR<Option>PA<Option>PR<Option>PW<Option>RI<Option>SC <Option>SD<Option>TN<Option>TX<Option>UT<Option>VA<Option>VI<Option>VT<Option>WA <Option>WI<Option>WV<Option>WY</Select> Zip: <input type="text" size="5" name="req-Zip">
Area Code: <input type="text" name="req-Area Code" size="3"> Phone Number: <input type="text" name ="req-Phone Number" size="8">
Alternate Contact Phone Number: <input type="text" name="req-Alternate Contact Phone Number" size=12>
Family E-Mail: <input type="text" name="req-Email" size="20">
<b><u>Order Information</u></b>
<b><Font Color="FF0000">***Vertical images will be printed as Vertical Cards.
Horizontal images will be printed as Horizontal Cards***</Font></b>
Item:<Select Name="item" Size ="1"><Option selected>Select<Option>25 Christmas Cards (NO IMPRINTNG) for $17.50<Option>50 Christmas Cards (NO IMPRINTNG) for $35.00<Option>75 Christmas Cards (NO IMPRINTNG) for $52.50<Option>100 Christmas Cards (NO IMPRINTNG) for $70.00<Option>25 Christmas Cards (WITH IMPRINTNG) for $27.50<Option>50 Christmas Cards (WITH IMPRINTNG) for $45.00<Option>75 Christmas Cards (WITH IMPRINTNG) for $62.50<Option>100 Christmas Cards (WITH IMPRINTNG) for $80.00</Select> Design Letter:<Select Name="Design Letter"Size="1"><Option selected>Select<Option>A<Option>B<Option>C<Option>D<Option>E<Option>F<Option>G<Option>H
<Option>I<Option>J<Option>K<Option>L<Option>M<Option>N<Option>O<Option>P<Option>Q</Select> Picture #:<input type="text" name="Picture Number" size="10">
<b><u>Imprint Information</b></u>
Imprint: <textarea name="Imprint" cols="30 rows="4"></textarea>
<B> We will not be responsible for Customer typographical errors</b>
<b>List additional notes in the Comment Field below about your order</b>
Comments:<textarea name="Comments" ROWS="3" COLS="40"></TEXTAREA>
<b><u>Shipping Information</u></b> <b><Font Color="FF0000">(This address must be same as the bill to address for the credit card)</Font></b>
Ship To Name: <input type="text" name="req-Ship To Name" size="40">
Street Address: <input type="text" name="req-Street Address" size="40">
City: <input type="text" name="req-City" size="15"> State: <Select Name="State" Size="1"><Option selected>Select<Option>AL<Option>AK<Option>AS<Option>AR<Option>AZ<Option>CA<Option>CO <Option>CT<Option>DE<Option>DC<Option>FL<Option>FM<Option>GA<Option>GU<Option>HI<Option>ID<Option>IL<Option>IN<Option>IA<Option>KS<Option>KY<Option>LA<Option>ME<Option>MH <Option>MA<Option>MD<Option>MI<Option>MN<Option>MS<Option>MO<Option>MT<Option>NE <Option>NV<Option>NH<Option>NJ<Option>NM<Option>NY<Option>NC<Option>ND<Option>MP <Option>OH<Option>OK<Option>OR<Option>PA<Option>PR<Option>PW<Option>RI<Option>SC <Option>SD<Option>TN<Option>TX<Option>UT<Option>VA<Option>VI<Option>VT<Option>WA <Option>WI<Option>WV<Option>WY</Select> Zip: <input type="text" size="5" name="Zip">
<b><u>Shipping and Handling will be added to ALL orders with the exception of in store pickup</u></b>
If you do not select a shipping Method your products will be sent via US Mail
Shipping Method: <Select Name="Shipping Method" Size="1"><Option selected>Select<Option>In-Store Pick-up<Option>US Mail - Flat Rate $3.50<Option>UPS - Rate as per weight<Option>Federal Express Overnight Delivery - Rate as per weight</Select>
<b><u>Payment Information</u></b> <b><Font Color="FF0000">(We accept Mastercard, Visa & Discover)</Font></b>
Credit Card Type: <Select Name="Card Type" Size="1"><Option selected>Select<Option>Mastercard<Option>Visa<Option>Discover</Select> Credit Card #: <input type="text" name="Credit Card" size="19"> Card ID #: <input type="text" name="req-Card ID #" size="4"
<font color="FF0000">Your Card ID # can be found on the back of your credit card listed after your account number.
It is a 3 or 4 dight number. Entering this number is used to verify that you have possession
of the credit card which you are attempting to use. It is for your own protection and it
is also a security feature of our website to protect against internet fraud.</font>
Card Expiration Date: <Select Name="Month" Size="1"><Option selected>Select<Option>01<Option>02<Option>03<Option>04<Option>05<Option>06<Option>07 <Option>08<Option>09<Option>10<Option>11<Option>12</Select> <Font Color="0000FF">month</Font> <Select Name="Year" Size="1"><Option selected>Select<Option>2007<Option>2008<Option>2009<Option>2010<Option>2011<Option>2012
<Option>2013 </Select> <Font Color="0000FF">Year</Font>
Enter in the box below the Total Dollar Amount of your order.All Prices includes tax.
Total Dollar Amount: <input type="text" name="req-Total Dollar Amount" size="6">
<b><u><font color="FF0000">-IMPORTANT INFORMATION - PLEASE READ!!!</Font></u></b>
<font color="FF0000"> By pressing the submit button below the customer agrees to the following:
-<u>Orders are not <b>CANCELABLE or REFUNDABLE.</b></u> Orders cannot be changed.
-ALL ORDERS ARE FINAL!
-Orders will not be filled until the customers credit card information has
been humanly verified by EAP's Accounting Department.</FONT>
<input type=submit value="Submit Order" name="Submit">
<font color="FF0000">You will receive an email response from our accounting department
when your order has been charged to your credit card. This normally takes 24-48 hours. After
pressing the submit button you will be presented with a <b><u>Thank You Page</b></u> confirming
your order. We suggest you print a copy of this page for your records. </font>
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</form>
