Order Form

General Information
Agency
 
Group Name *
Group Leader *
GL Phone * ( ) - ext
GL Email *
GL Email is used to contact the GL to determine which program type is preferred. (Program Type Examples: digital camera, sd card, usb flash drive, etc.)
Check this box if you do not have a GL Email.
 
Destination *
Group Type *
Sales Rep *
Client Tour Code
 
Dates
Departure Date * / /
Return Date * / /
 
Camera Need Date
/ /
Video Need Date
/ /
Last Day of School / /
 
Shipping Information
Camera Address
  Ship to Agency
Street Address *
Street Address cont.
City, State Zip * ,
 
Video Address
  Agency    Same as Cameras
Street Address *
Street Address cont.
City, State Zip * ,
Pricing Summary
 
Qty Service Price Line
DVDs * $0.00  
20x30 PhotoMozaix™ $35.00  
Learn More About PhotoMozaix™
Group Photos $10.00  
Extra Cameras
$50.00  
Buses *    
    Discount
    Subtotal
    Tax
Total
 
Comments
 
Submit Order

* denotes required field