*Students Name Organization *Street Address Address (cont.) *City *State/Province *Zip/Postal Code *Country *Phone E-mail
*QTY *DESCRIPTION (multiple choices allowed by holding Shift and clicking left mouse button) 01 02 03 04 05 06 Cherney Dance Studio Recital Video (6/21/03 -1pm show) - $45..00 (includes s/h) $55.00 after 6/13/03 Cherney Dance Studio Recital Video (6/21/03 -5pm show) - Video Tape $45.00 (includes s/h) $55.00 after 6/13/03 Cherney Dance Studio Recital Video (6/21/03 -1pm show) $100.00 DVD (includes s/h) $110.00 after 6/13/03 Cherney Dance Studio Recital video (6/21/03 -5pm show) $100.00 DVD (includes s/h) $110.00 after 6/13/03 Dance Attitudes of Hamilton Recital Video 2003 (May 10 - early show) - $52.00 Dance Attitudes of Hamilton Recital Video 2003 (May 10 - late show) - $52.00 Dance Attitudes of Hamilton Recital Video 2003 (May 10 - early show) $105.00 DVD Dance Attitudes of Hamilton Recital Video 2003 (May 10 - late show) $105.00 DVD Dance Attitudes of Marlboro Recital Video 2003 (May 16 ) - $55.00 after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 16 ) $105.00 DVD after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 17 early show) - $55.00 after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 17 - late show) $55.00 after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 17, early show) $105.00 DVD after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 17, late show) $105.00 DVD after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 18 early show) $55.00 after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (lMay 18- late show) $55.00 after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 18, early show) $105.00 DVD after 5/9/03 Dance Attitudes of Marlboro Recital Video 2003 (May 18, late show) $105.00 DVD after 5/9/03 St. Ann's Church Communion 2003 (May 3 - 9am) - $35.00 Photo St Ann's Church Communion 2003 (May 3, 11:00am) -$35.00 photo St. Ann's Church Communion 2003 ( May 3, 9am) $40.00 Video St. Ann's Church Communion 2003 (May 3, 11am) $40.00 Video St. Ann's Church Communion 2003 (May 3, 9am) $55.00 DVD St. Ann's Church Communion 2003 (May 3, 11am) $55.00 DVD Rutgers-Newark Graduation Video 2003 - (May 22) - $40.00 ($5.00 s/h included) Rutgers-Newark Graduation Video 2003 (May 22) $55.00 DVD ($5.00 s/h included) St Stanislaus Church Communion 2003 (May 3) - $40.00 St Stainislaus Church Communion 2003 (May 3) $60.00 DVD Allegro Dance Academy Video 2003(June 22, 11:30am ) - $45.00 after 6/13/03 $55.00 Allegro Dance Academy Video 2003 (June 22, 3pm) $45.00 after 6/13/03 $55.00 Allegro Dance Academy Video 2003 (June 22, 11:30 am) $75.00 DVD after 6/13/03 $85.00 Allegro Dance Academy Video 2003 (June 22, 3:00pm) $75.00 DVD after 6/13/03 $85.00 St. Benedicts Church Communion 2003 (May 3) $40.00 St. Benedicts Church Communion 2003 (May 10th) $40.00 St. Benedicts Church Communion 2003 (May 17th) $40.00 Rising Stars Recital Video 2003 (May 31st, Show 1) $40.00 After May 23, $50.00 Rising Stars Recital Video 2003 (May31st, Show 2) $40.00 after May 23, $50.00 Rising Stars Recital Video 2003 (May 31st, show 3) $40.00 after May 23, $50.00 Rising Stars Recital Video 2003 (May 31st, Show 1) $95.00 DVD after May 23, $105.00 Rising Stars Recital Video 2003 (May 31st,show 2) $95.00 DVD after May 23, $105.00 Rising Stars Recital Video 2003 (May 31, Show 3) $95.00 DVD after May 23, $105.00 Rising Stars Recital Video 2003 (June 1, Show 1) $40.00 after May 23, $50.00 Rising Stars Recital Video 2003 (June 1, Show 2) $40.00 after May 23, $50.00 Rising Stars Recital Video 2003 (June 1, Show 3) $40.00 after May 23, $50.00 Rising Stars Recital Video 2003 (June 1, show 1) $95.00 DVD after May 23, $105.00 Rising Stars Recital Video 2003 (June 1, Show 2) $95.00 DVD after May 23, $105.00 Rising Stars Recital Video 2003 (June 1, Show 3) $95.00 DVD after May 23, $105.00
PAYMENT *if paying by check or money order, please print out this completed form and remit along with payment to: Galis Photography & Video Inc. 850 Rte 1 No. 3rd Floor North Brunswick, NJ 08902 (make check/money order payable to Galis Photography & Video Inc.) *Method of Payment Credit Card Check Money Order *Credit Card VISA MasterCard American Express Discover *Cardholder Name *Card Number *Expiration Date *V-Code (Last 3 -Digit Number on Back of Credit Card) Ship Product(s) - (if "yes", add $10 s/h per item - select "no" to p/u your item at event location) Yes No SHIPPING INFO same as above Street Address Address (cont.) City State/Province Zip/Postal Code Country
*Credit Card
Ship Product(s) - (if "yes", add $10 s/h per item - select "no" to p/u your item at event location)
Yes No