Please print, fill out, and submit a signed copy of this form along with your payment and image(s) that you want to be printed. Any submission of photographic material to Danny Burk Photography, LLC (DBP) signifies your agreement with all of the following terms, even if your signed copy of this form is not included with your order.

Clients submitting photographic material must be the copyright holder of this material, and warrant that this material does not infringe upon any copyright, trademark, or other interests or rights of any third party. Clients agree that if any dispute over such interests or rights should arise, DBP must be held harmless and without any liability whatsoever to claims of either party.

By submitting image(s) for Custom Printing, clients agree that DBP is entitled to reproduce and otherwise process these images for return to the client. No images will be retained or otherwise used by DBP, and ownership of copyright remains with the client.

No images featuring nudity, obscenity, or pornography will be accepted for Custom Printing. Any such images submitted to DBP will be returned unprocessed at the client’s expense.

DBP makes every effort to handle submitted material with great care, yet (as with any image submission) there remains a slight risk of damage to materials during handling and processing. Clients must assume this risk and agree that DBP’s liability is limited only to replacement of this material with like unprocessed material of similar type, and waives any and all potential claims against DBP. DBP assumes no liability for loss or damage to submitted materials incurred while in transit.


Name:________________________________________ Address:____________________________________
City, State,Zip:_____________________________________________________
Phone:_____________________________ Email:_______________________________________________
Date:______________________________ SIGNATURE:__________________________________________


If you are submitting more than 5 images, please list additional material on a second sheet. Payment in full must accompany all orders. Cost of Custom Prints is not refundable; a print will only be reprinted without additional charge if it is physically defective. Payment may be made by cheque or money order, payable to Danny Burk Photography, LLC; DBP is not accepting credit cards at this time.

Material and payment may be sent to:

Danny Burk Photography

2717 Twixwood Lane

South Bend, IN 46614

Please notify me that you are shipping the material so that I'll watch for its arrival. Also, please note that I am sometimes away for 1-2 week periods; if you want to be certain that I can attend to your order promptly, I'll be happy to respond to your turnaround time inquiries by email.


  Image Filename Print size Qty. Paper choice Price per print Total price






















Optional: 8x10 Proof print(s), $10.00 per proof plus $8.00 shipping. (Shipped via Priority envelope)  
Notes:   Subtotal:  

8x10 and 11x14 prints:

Return shipping (within USA):

 US Priority Mail =        $14.00;

 Fed Ex or UPS email for quote

Larger than 11x14 prints:

Return shipping (within USA):

  US Priority Mail    =    $17.00;

  Fed Ex or UPS email for quote

Indiana residents: 7% sales tax on prints and all shipping fees  
  Total payment enclosed: