QC DANCE SECURE ON-LINE ORDER FORM

Name & Address Information

Your Name
E-Mail Address
Student Name
Picture Date
Picture Time

Your Mailing Address
Street Address
Apt./Suite #
City
State
Zip Code
Telephone Number

--- Pictures to Order ---

** Please use 1 row for each costume you wish to have photographed **

Individual Pictures

Picture Choice - Price	Quantity	Dance Style	Costume Color

-- 7.525 % Minnesota Sales Tax will be added to all orders --

Payment Method

Credit Card Information

Credit Card Number

Exp. Date
2 Digit Month - 2 Digit Year
-

CCV

* Please Note * Your shipping address above must match the
address where your credit card statements are sent.
Your credit card will not be charged until pictures are taken.

Delivery

Pictures will be delivered to the Dance School
1-2 weeks after picture day.