AERIAL IMAGERY ORDER FORM Michigan Department of Natural Resources, Forest, Mineral and Fire Management Division January 1, 2007 Name, company________________________________________________________________________________ Street address (not PO box)_______________________________________________________________________ City, state, zip code _____________________________________________________________________________ Telephone, e-mail ______________________________________________________________________________ IMAGE IDENTIFICATION List the three-part image number from index map, such as 768-33-164 PAYMENT Make check or money order payable to “State of Michigan” or charge to credit card (VISA or MasterCard) __________________________________________ Card number________________________________ __________________________________________ Expiration date______________________________ SITE LOCATION If ordering a digital scan or photographic enlargement, provide map with area of interest highlighted or detailed description of area, such as county name and T42N, R3W, Section 5, SE¼ __________________________________________ Signature___________________________________ DELIVERY Normal delivery time is two weeks. Standard shipping is UPS-Ground. Expedited delivery can be arranged through contact person below. __________________________________________ CHECK PRODUCT TYPE AND IMAGE YEAR Refer to price list  Digital scan  1978  Clear film (9 x 9)  1986  Print (9 x 9)  1987  Print (18 x 18) (1”=660’)  1988  Print (18 x 18) (1”=400’)  1997  Print (18 x 18) (1”=300’)  1998  Print (18 x 18) (1”=200’)  1999  Print (18 x 18) (1”=100’) COST OF ORDER SUBMIT TO Sherman Hollander DNR-FMFM PO Box 30452 Lansing MI 48909-7952 Tel. 517-373-9123 (Fax 517-373-2443) hollands@michigan.gov DNR ACCOUNTING  73550-51310-9042 (taxable)  73550-51310-9029 (tax)  73550-51310-9043 (nontaxable) Total product charges (see price list)_____________ Processing fee per order___________________$6.00 Subtotal____________________________________ 6% sales tax (Michigan residents) _______________ Total amount of order _________________________ American LegalNet, Inc. www.FormsWorkflow.com