<form method="POST" Action="/_ihnextras/cgi/cgishell.exe?REPLYTOVENDOR">
<input type="hidden" name="Recipient" value="Orders@eapphoto.com">
<input type="hidden" name="Subject" value="EAP Dance DVD Order">
<input type="hidden" name="redirect" value="http://www.eapphoto.com/eap_web_107.htm"
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<b><u>Customer Information</u></b>
Child's First Name: <input type="text" name="req-Child'sFirst Name" size="10"> Child's Last Name: <input type="text" name="req-Child's Last Name" size="20">
Street Address: <input type="text" name="req-Street Address" size="30">
Suite / Apt. #: <input type="text" name="Suite / Apt. #" size="10">
City: <input type="text" name="req-City" size="15"> State: <Select Name="State" Size="1"><Option selected>Select<Option>AL<Option>AK<Option>AS<Option>AR<Option>AZ<Option>CA<Option>CO <Option>CT<Option>DE<Option>DC<Option>FL<Option>FM<Option>GA<Option>GU<Option>HI<Option>ID<Option>IL<Option>IN<Option>IA<Option>KS<Option>KY<Option>LA<Option>ME<Option>MH <Option>MA<Option>MD<Option>MI<Option>MN<Option>MS<Option>MO<Option>MT<Option>NE <Option>NV<Option>NH<Option>NJ<Option>NM<Option>NY<Option>NC<Option>ND<Option>MP <Option>OH<Option>OK<Option>OR<Option>PA<Option>PR<Option>PW<Option>RI<Option>SC <Option>SD<Option>TN<Option>TX<Option>UT<Option>VA<Option>VI<Option>VT<Option>WA <Option>WI<Option>WV<Option>WY</Select> Zip: <input type="text" size="5" name="req-Zip">
Area Code: <input type="text" name="req-Area Code" size="3"> Phone Number: <input type="text" name ="req-Phone Number" size="8">
Alternate Contact Phone Number: <input type="text" name="req-Alternate Contact Phone Number" size=12>
Family E-Mail: <input type="text" name="req-Email" size="20">
<b><u>Order Information</u></b>
Dance School Name: <Select Name="Dance School Name" Size="1"><Option selected>Select<Option>Joanne's Dance Studio</select>
Please select in the boxes below the Show Date and Time.
Show Date:<Select Name="Show Date" Size="1"><Option selected>Select<Option>May 6th, 2006<Option>May 20th, 2006<Option>May 21st, 2006<Option>May 27th, 2006<Option>May 28th, 2006<Option>June 3rd, 2006<Option>June 4th, 2006<Option>June 9th, 2006<Option>June 10th, 2006<Option>June 11th, 2006<Option>June 16th, 2006<Option>June 17th, 2006<Option>June 18th, 2006<Option>June 24th, 2006<Option>June 25th, 2006<Option>June 28th, 2006<Option>June 29th, 2006<Option>July 2nd, 2006</Select> Show Time:<Select Name="Show Time" Size="1"><Option selected>Select<Option>10:00am<Option>11:00am<Option>12:00pm<Option>12:30pm<Option>1:00pm<Option>1:30pm<Option>2:00pm<Option>2:30pm<Option>3:00pm<Option>3:30pm<Option>4:00pm<Option>5:00pm <Option>5:30pm<Option>6:00pm<Option>6:30pm<Option>7:00pm<Option>7:15pm<Option>7:30pm<Option> 8:00pm</select>
Would you like to purchase the show on DVD or Video? <Select Name="Media" Size="1"><Option Selected<Option>Select<Option>DVD<Option>Video</Select>
<b><u>Shipping Information</u></b> <b><Font Color="FF0000">(This address must be same as the bill to for the credit card)</Font></b>
Ship To Name: <input type="text" name="req-Ship To Name" size="40">
Street Address: <input type="text" name="req-Street Address" size="40">
City: <input type="text" name="req-City" size="15"> State: <Select Name="State" Size="1"><Option selected>Select<Option>AL<Option>AK<Option>AS<Option>AR<Option>AZ<Option>CA<Option>CO <Option>CT<Option>DE<Option>DC<Option>FL<Option>FM<Option>GA<Option>GU<Option>HI<Option>ID<Option>IL<Option>IN<Option>IA<Option>KS<Option>KY<Option>LA<Option>ME<Option>MH <Option>MA<Option>MD<Option>MI<Option>MN<Option>MS<Option>MO<Option>MT<Option>NE <Option>NV<Option>NH<Option>NJ<Option>NM<Option>NY<Option>NC<Option>ND<Option>MP <Option>OH<Option>OK<Option>OR<Option>PA<Option>PR<Option>PW<Option>RI<Option>SC <Option>SD<Option>TN<Option>TX<Option>UT<Option>VA<Option>VI<Option>VT<Option>WA <Option>WI<Option>WV<Option>WY</Select> Zip: <input type="text" size="5" name="req-Zip">
<b><u>Shipping and Handling will be added to ALL orders</u></b>
If you do not select a shipping Method your products will be sent via US Mail
Shipping Method: <Select Name="Shipping Method" Size="1"><Option selected>Select<Option>US Mail - No Extra Charge<Option>UPS - Rate as per weight<Option>Federal Express Overnight Delivery - Rate as per weight</Select>
<b><u>Payment Information</u></b> <b><Font Color="FF0000">(We accept Mastercard, Visa & Discover)</Font></b>
Credit Card Type: <Select Name="Card Type" Size="1"><Option selected>Select<Option>Mastercard<Option>Visa<Option>Discover</Select> Credit Card #: <input type="text" name="req-Credit Card" size="19"> Card ID #: <input type="text" name="req-Card ID #" size="4"
<font color="FF0000">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.</font>
Card Expiration Date: <Select Name="Month" Size="1"><Option selected>Select<Option>01<Option>02<Option>03<Option>04<Option>05<Option>06<Option>07 <Option>08<Option>09<Option>10<Option>11<Option>12</Select> <Font Color="0000FF">month</Font> <Select Name="Year" Size="1"><Option selected>Select<Option>2006<Option>2007<Option>2008<Option>2009<Option>2010<Option>2011 </Select> <Font Color="0000FF">Year</Font>
<b>List additional notes in the Comment Field below about your order if necessary</b>
Comments:<textarea name="Comments" ROWS="6" COLS="50"></TEXTAREA>
<b>Select in the box below the Total Dollar Amount of your order.
All Prices listed include tax.<b>
Total Dollar Amount: <Select Name="req-Total Dollar Amount"Size="1"><Option selected>Select<Option>$45.00</Select>
<b><u><font color="FF0000">-IMPORTANT INFORMATION - PLEASE READ!!!</Font></u></b>
<font color="FF0000"> By pressing the submit button below the customer agrees to the following:
-<u>Orders are not <b>CANCELABLE or REFUNDABLE.</b></u> 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.</FONT>
<input type=submit value="Submit Order" name="Submit">
<font color="FF0000">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 <b><u>Thank You Page</b></u> confirming
your order. We suggest you print a copy of this page for your records. </font>
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</form>
1. Fill in the information below and then submit your order.
All Blanks MUST be filled in for your order to be processed
2.After your order is received you will get an emailed confirmation from our production department. This normally takes 24-48 hours after your order is submitted.
This order form is for shows that will take place in 2006 or took place in 2006.
For shows that took place in 2005
