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Welcome to the Firefly Images Online Order
Form
You may use this form to place an order for Father/Daughter Dance photos using a credit card. Price includes tax. Shipping is separate and is required for Home School and out of District students. Please submit 1 form per family, limited to one complimentary image per family.
Name of School
*
Student First Name
*
Student Last Name
*
Grade
*
Teacher Name (type NA if not applicable)
*
Parent First Name
*
Parent Last Name
*
Phone Number
*
Email Address
*
Mailing Address
*
Packages
Please enter the quantity of each package you would like to order:
Package A - Complimentary 5x7 Photo No Charge!
Package B - 2-5x7s, 2-3x5s, 4-Wallets $20.00
Package C - 1-8x10, 2-5x7s, 8-Wallets $30.00
Package D - Digital Download $25.00
Package E - 1-5x7 $10.00
Package F - 2-3x5s $10.00
Package G - 4 Wallets $10.00
Package H - 8 Mini Wallets $10.00
Package I - 1-4x5 Magnet $10.00
Package J - 1-8x10 $15.00
Package K - 2-5x7s $15.00
Package L - 4-3x5s $15.00
Package M - 8 Wallets $15.00
Package N - 2-4x5 Magnets $15.00
Shipping
Shipping is Optional, if you do not chose this option, your package will be sent to your student's school.
Shipping is Required for Home School students and Out of District students.
Shipping $6.00
Credit Card Information
Credit Card Type
*
Visa
MasterCard
Card Number
*
Exp Date (MM/YY):
*
CVV
*
Billing/Shipping Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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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
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Comment or Question?
Firefly Images
206-790-3696
fireflyimages@comcast.net
FireflySchoolPhotos.com