Please print, fill out, and submit a signed copy of this form along with your payment and image(s) that you want to be drum scanned. 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 scanning, 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 scanning. 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:__________________________________________


Please submit transparencies or negatives in individual sleeves or glassines. All material must be removed from mounts. Film must be cut rather than submitted in strips; if you submit strips THEY WILL BE CUT FOR PROCESSING. No exceptions!

Important note on 35mm slides: these should be submitted removed from mounts. If you submit slides in mounts, there is an extra $2 handling fee per slide (no discount)!

If you are submitting more than 10 images, please list additional material on a second sheet. Payment in full must accompany all orders. Payment may be made by cheque or money order, payable to Danny Burk Photography, LLC

Film and payment may be sent to:

Danny Burk Photography

2717 Twixwood Lane

South Bend, IN 46614

Please notify me that you are shipping film so that I'll watch for its arrival. 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. Normal turnaround time is 2-3 days unless you have a large order.


Click "Print" in the browser bar for a printable copy"

  Image Film size Resolution
IMPORTANT! You may choose either a 10% or 15% quantity discount, or a 20% "no dust spotting" discount, but not both. Subtotal:  
Discount (if applicable):  

Return shipping (within USA):

  USPS Priority Mail       8.00


FedEx is available; I'll check the cost upon request. FedEx rates have become extremely high: for example, overnight to western states is currently over $50.00 !
Total payment enclosed: