Verge Video Productions   6915 Thrasher Drive - Tampa, FL 33610

Live Performance Picture Order Form

Name ______________________

Address ______________________

______________________

Phone/email _____________________

1 Page = $15.00/image

Choose from the following Page/Photo Sizes: 

A.(1) 8x10; B.(2) 5x7; C.(8) Wallet; or D.(1) 5x7 & (4) Wallet

Custom Editing = $15.00 additional

(Give description under order line below)

Image #                 Page/Photo Size                      Cost

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

Please Add $5.00 s/h and 7% FL sales tax.

Total: $ ______

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