Verge Video Productions

6915 Thrasher Drive - Tampa, FL 33610

(813) 628-9089 - vergevideo.com

Central Florida Dance Celebration

January 12, 2008 – Lakeland, Florida

Photo Order Form

Name ______________________

Address ______________________

______________________

Phone/email _____________________

Prices:

5 X 7= $5.00; 8X10 = $10.00;

Custom Editing = $15.00 additional (Call Please)

Photo Qty. Size Cost

___________________________________________________________

Please Add $5.00 s/h

Total: $ ______

Make checks payable to: Verge Video Productions. Allow 4 - 6 weeks for delivery.