DVD Video Online Form 1

Customer Information

Child's First Name: Child's Last Name:

Street Address:

Suite / Apt. #:

City: State: Zip:

Area Code: Phone Number:

Alternate Contact Phone Number:

Family E-Mail:

Order Information

Dance School Name:

Please select in the boxes below the Show Date and Time.

Show Date: Show Time:

Would you like to purchase the show on DVD or Video?

Shipping Information (This address must be same as the bill to for the credit card)
Ship To Name:

Street Address:

City: State: Zip:

Shipping and Handling will be added to ALL orders

If you do not select a shipping Method your products will be sent via US Mail

Shipping Method:

Payment Information (We accept Mastercard, Visa & Discover)

Credit Card Type: Credit Card #: Card ID #: Your Card ID # can be found on the back of your credit card listed after your account number. It is a 3 or 4 dight number. Entering this number is used to verify that you have possession of the credit card which you are attempting to use. It is for your own protection and it is also a security feature of our website to protect against internet fraud.

Card Expiration Date: month Year

List additional notes in the Comment Field below about your order if necessary

Comments:

Select in the box below the Total Dollar Amount of your order. All Prices listed include tax.

Total Dollar Amount:

-IMPORTANT INFORMATION - PLEASE READ!!! By pressing the submit button below the customer agrees to the following: -Orders are not CANCELABLE or REFUNDABLE. Orders cannot be changed. -ALL ORDERS ARE FINAL! EAP Photo Service will replace a DVD with a Videocassette if our DVD doesn't play on your DVD player. No money will be refunded for the difference between the price of the DVD and the Videocassette. -Orders will not be filled until the customers credit card information has been humanly verified by EAP's Accounting Department.

You will receive an email response from our accounting department when your order has been charged to your credit card. This normally takes 24-48 hours. After pressing the submit button you will be presented with a Thank You Page confirming your order. We suggest you print a copy of this page for your records.