Mail this completed form to: Photography by Lynn Branam LLC, 219 Main Street, Westcliffe, CO 81252

Name: _______________________________________________

Address: _____________________________________________

City/State/Zip : _________________________________________________

Phone number (for questions about your order):  __________________________

Make check or money order payable to: Photography by Lynn Branam, LLC.  For your protection, all credit card sales require that we have your credit card billing address to process this order:

Circle Type of card:     Visa      MasterCard     DISCOVER      American Express

Card Number: ________________________________________________________

Expiration Date: ____________________________ CVV: ____________________

You can also order with your credit card by calling 719-783-3533