Pergamon Design    
 

Order Form

Yes, I would love to have you make a video of our adoption trip! Below is my contact information:

First Name
Last Name
Child's name
Street Address
City
State
Country
Zip
Phone number (with area code) - -
Email
Email

(Yes, it's here twice to guard against typos! )

 
 
My original materials of the trip will be:
   

Please specify the format of your video below:
 
I am sending a CD of the music we would like.

Name(s) of song chosen:

song #1

song #2

song #3

song #4


Title of video (to appear at the beginning of the tape) The default title will be your child's first name

I would like the finished Video project mastered to:

 
 
$349.00 (USD)
  OR
$550.00 (USD)
OR
$700.00 (USD)
  I would like extra copies of the finished video:
Quantity Additional DVD disks at $25.00 each
 
I have two or more children to make videos for.
I want the 10% family discount!

Return shipping cost of your original materials and finished video is $25.00

Comments or questions:


 

Pergamon Film & Video
12245 SW Faircrest Street
Portland, OR, USA 97225
[503]320-9887

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© 2002, 2003, 2004 Pergamon Film & Video