Online Restoration Request Form
* denotes required field
CONTACT INFORMATION
*Name
*email
*Phone
I prefer to be contacted by:
 email
Phone
I am sending my photo file:
 by email
 on CD
I prefer to have my completed file:
 emailed to me
shipped on CD
REQUIRED FOR SHIPPING PRINTS:
Shipping Address:
City:
 State:
 Zip:
PHOTO INFORMATION
Photo / Subject Description:
Type:
B&W
 Sepia
 Hand Tinted
Color
 Tintype:
 Other
Damage Description (Check all that apply)
B&W Fading
 Color Fading
 Exposure Issues
Scratches
 Stains
 Spots
Creases
 Torn
 Missing Parts
Other - Please Describe
Please explain your vision for the finished project:
What print size do you want?
Same as original
 4x5
 5x7
 8x10
Other - Explain
Other questions and comments:
If you are using a special or coupon
code, please enter it in the box to the left.
*
I have read, understand and agree to the terms of
service and copyright information at:
www.heritage-photo-restoration.com/policy.html
Type Yes
to Agree
Hi!

Please fill out this restoration request
form to the best of your ability and
with as much information as you're
able to provide.  If you don't know
how to describe something, leave it
blank and when I talk (or correspond)
with you, I'll clarify any questions I
have.

Thanks!
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