Customer Order Form

Digital

Media Expressions

Customer Order Form

Order One DVD Media Expression $30.00

Order Multiple Copies Now Only $10.00 Each Additional DVD Yes How Many?

Purchaser (Must agree with Payment Information)

Name:

Street Address: Apt.

City: State: Zip Code:

Phone: Email:

An Email will be sent to the Purchaser upon shipment of Media Expression(s)

Shipping/Recipient Information (If Same As Above Leave Blank)

Name:

Street Address: Apt.

City: State: Zip Code:

Phone: Email:

Production Information

Event/Occasion: (example: Birthday, Mother's Day, Graduation)

Gift? Yes If YES, To: From:

Song Title: Artist:

Do You Need Help With Selection Yes (Please complete the following section)

(We Give Our Best Effort to Assist in Matching the Song Appropriate to the Nature of the "Media Expression")

Please Choose Genre:

Rock Pop Classical Country Oldie (pre 1990s) Decade:

Other:

Preferred/Favorite Artist:

Special Instructions

I have read and understood the Terms of Service

Preferred Method For Us to Contact You - Please Select Email Telephone

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