You may use this form to place an order for Father/Daughter Dance photos using a credit card. Price includes tax and shipping.

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 *

Packages

Please enter the quantity of each package you would like to order:

	Package A - Complimentary 5x7 Photo - No longer available!
	Package B - 2-5x7s, 2-3x5s, 4-Wallets $20.00 + $5 shipping
	Package C - 1-8x10, 2-5x7s, 8-Wallets $30.00 + $5 shipping
	Package D - Digital Download $25.00
	Package E - 1-5x7 $10.00 + $3 shipping
	Package F - 2-3x5s $10.00 + $3 shipping
	Package G - 4 Wallets $10.00 + $3 shipping
	Package H - 8 Mini Wallets $10.00 + $3 shipping
	Package I - 1-4x5 Magnet $10.00 + $3 shipping
	Package J - 1-8x10 $15.00 + $4 shipping
	Package K - 2-5x7s $15.00 + $4 shipping
	Package L - 4-3x5s $15.00 + $4 shipping
	Package M - 8 Wallets $15.00 + $4 shipping
	Package N - 2-4x5 Magnets $15.00 + $4 shipping

Please answer the following question:
*

Which background were you photographed on?

Credit Card Type *

Card Number *

Exp Date (MM/YY): *

CVV *

Billing/Shipping Address *

Address Line 2

City *

State *

Zip Code *

Comment or Question?