This order form is for the benefit of our current clients, if you are not currently a client or
would like to order individual images please access our ordering system.

Newspaper Image
Newspaper Image Please note that you must first submit, before filling out this form, your information to the newspapers. Kansas Memories cannot submit any information except for your photograph. Please allow up to 3 business days for images to reach newspaper. Please follow up with your newspapers to ensure that they received the image. We are not responsible for images that are submitted to the newspaper, but never received by the newspaper. Please enter first four digit number from image in box below.
Newspaper Image
Newspaper 1 Email Address
Newspaper 2 Email Address
Newspaper 3 Email Address
Newspaper 4 Email Address

Contact Information
*Required information
*Name
*Bride's Maiden Name
*e-mail address
*Address
*City
*State	--Select a State or Province-- Outside US Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming --Other US-- American Samoa Federated States Of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Virgin Islands --US Military-- Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific --Canadian Provinces-- --Select-- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Territory
*Zip	-
*Phone
Best Time to Contact

Additional Comments:

WE WILL SEND NOTIFICATION OF RECEIPT OF THIS ORDER WITHIN 24 HOURS, MONDAY-FRIDAY.
IF YOU DO NOT RECEIVE THIS NOTICE PLEASE CONTACT US.