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Student Portrait Order
Queen City Photography
1525 Churchville Ave
Staunton VA 24401
 
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*

School*

Student ID

Student First Name*

M.I.

Last Name:*

Teacher Name:*

 
Individual prints and products are available only with purchase of package(s)
Packages
Enter Your Product Selections Below
Item DescriptionItem PriceQuantityTotal
Digital Package: Individual Images emailed to you
Package 1: 4-5x7 8-wallets
Pose:
A
B

Package 2: 1-8x10, 4-5x7, 8-wallets
Pose:*
A
B

Package 3: 2-8x10, 4-5x7, 16-wallets
Pose:*
A
B

Premier : 1-11x14, 2-8x10, 4-5x7, 24-wallets
Pose:*
A
B

Package ordered.*
 

package validation
Individual prints and products are available only with purchase of package(s)
Prints
Two (2) - 4x6
(2)5x7
8x10
11x14
4 Wallets
8 Wallets
Products
Mouse Pad
Canvas Tote
Coffee Mug 11oz
Bag Tag
Magnet (3.5 x5)
Keychain: Silver - 1"
Dog Tag
Key Tags
Shipping ($5.00):
Grand Total:
 
Special Instructions:

Billing Information
Parent Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Phone:*

Same as SHIPPING information?
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Shipping Information
First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Phone:

City:*

State:*

Zip Code:*

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