Reflection Albums

Name:

Email:

Alternate Email:

Shipping Address for Video

Street Address

City:

State:

Zip Code:

Home Phone:

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Work Phone:

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Cell Phone:

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Preferred Method of Contact

First/Last Name of the Person
Video is Being Made For

Please Select Your Video Package
Click to View Video Packages

Video Occassion

Date of Special Event

How did you hear about Reflection Albums?

If your purchase needs to be discreet, please let us know! We will help to keep your Video a surprise by discreet mailing as well as phone calls.

Yes be discreet No discretion is needed

We are happy to scan your photos for you for .50 cents each if you have no way of scanning them yourself.

Please scan photos for me I'll scan my own

One DVD is included in your package price. Additional DVD's are $25 each. How many additional copies would you like?

DVD

We require at least 2 weeks with your photos. Do you require a rush order for your video? If so, the service charge is 20% of your package price. Do you need a rush order?

Yes No

Music Selection (fill in the boxes below)

Song #1		Artist #1
Song #2		Artist #2
Song #3		Artist #3
Song #4		Artist #4
Song #5		Artist #5
Song #6		Artist #6
Song #7		Artist #7
Song #8		Artist #8

Special Instuctions:

By submitting my order form, I'm acknowledging that I have read and agree to the Reflection Album Terms of Service

Soon after you submit your order you will be contacted by a RA Representative to discuss payment options and details of your Video Album!

Thank you!