Picture Supreme Photo Order Form

Contestants name      Age      DOB 
Address   City   State    Zip 
Email address    Phone 
Parents Name     Pageant Attending
Registration Number     Description of child & clothing 


PLEASE FILL OUT A SEPARATE ENTRY FORM FOR EACH SIBLING.  APPLY DISCOUNT IN SPACE PROVIDED.

Order Form

Stage Shots $45
DVD   $45
Both $80
Pre-Order Discount (Both $75)
Payment
(Must be paid in full
to get pre-order discount)		 -
Balance Due at Registration
By signing below  you agree that Picture Supreme and/or Joyce DeBoer may use contestant's names and pictures for future advertisement in print, banners, and on the systems personal website.  Please make checks payable to: Joyce DeBoer.   Deposits and fees may be paid by cashiers check, cash, or money order only.  Please mail deposits to: Joyce DeBoer C/O PictureSupreme, 1310 Coolidge Ave, Pekin, IL  61554.  Please allow 15 days for check clearing before I begin working on your photos/video.  Signing this form constitutes a legal and binding contract.
Digital Signature
Date

Please select your method of payment