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Name: * First Last
Personal Information
Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Shipping Information - Shipping and Handling varies due to amount of orders placed. Minimum amount of $10 is required for shipping.
Date of Event: * MM / DD / YYYY
Package Selection and Event Type: *
Gold Package (75 Pics, 1 Copy) - $199.00 Plus State Tax Silver Package (50 Pics, 1 Copy) - $149 Plus State Tax Bronze Package (25 Pics, 1 Copy) - $99.00 Plus State Tax
Event Type *
Wedding Birthday Graduation Retirement Anniversary Tributes/Memorials Family Reunions Pets Other
DVD Quantity: *

Type how many DVDs you would like...
Photographs: *

Using post-it notes, please number the pictures in the order in which you would like them to appear in the video. There is a $2.00 fee for each additional photograph over amount listed in package.
End Sentiment and Back of DVD Synopsis Sentiment: *

A special sentiment of 30 words of less, such as scripture, poem, eulogy, etc. Please write the sentiment as you would have it appear at the end of video.

A special sentiment of 50 words of less, such as scripture, poem, eulogy, etc. Please write the sentiment as you would have it appear on the backside of the DVD case.
Name of Person being Celebrated: *

Ex: John and Jane Smith- 25th wedding Anniversary
Picture Selection for Front of Case: *

Please select one (1) picture from your submission for the front cover of the DVD by listing the number: #_______

Ex: Picture with post it note #14
Do Not Fill This Out

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