Glamour Portrait Gift Order Form

Name:

Address:

City: Province:

Postal Code:

Phone Number:

Email:

Credit Card: Visa Mastercard American Express Expiry Date: January February March April May June July August September October November December 2002 2003 2004 2005 2006 2007 2008 2010

Which Package would you like?

Pak #1 $49.95 0 1 2 3 4 5 6 7 8 9 10 How Many?

Pak #2 $99.99 0 1 2 3 4 5 6 7 8 9 10 How Many?

Pak#3 $149.99 0 1 2 3 4 5 6 7 8 9 10 How Many?

Taxes and shipping will be added to your order and a receipt will be sent via email.

Thank you.