ADC

1630 Pleasant Hill Rd.

Suite 180-100

Duluth, GA 30096

(770) 554-1309

     ORDER FORM (Please print out and use front & back as necessary)

Name: ____________________________________________________

Address: ______________________________City: ________________

State: _____ Zip: _________

Home Phone: ______________ Work Phone ___________Surprise? ( yes or no)____

Beginning Message ____________________________________________________

Ending Message _______________________________________________________

What should label on video say? __________________________________________

Background Music

Selection 1: Name of Song______________________________

Pictures Numbered ______to______

Selection 2: Name of Song______________________________

Pictures Numbered _____to______

Selection 3: Name of Song______________________________

Pictures Numbered ______to______

Selection 4: Name of Song______________________________

Pictures Numbered _____to_____

Selection 5: Name of Song______________________________

Pictures Numbered _____to_____

Use the back for additional space.

Price your production:

_______ Photos @ $2.00                             $______

_______ Songs @ $5.00                              $______

_______ Title Slides @ $4.00                       $______

_______ Text Over Pictures @ $1.00           $______

_______ Specialized Music @ $5.00            $______

_______ Additional Videotapes @  $6.00     $_______

________ Additional DVD’s @ $10.00       $_______

Please make checks payable to Mary Ann Marcus.    

50% Deposit Due at Order.  Balance Due at Delivery.                 

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