INDIVIDUAL/SIBLINGS PHOTO ORDER FORM

131 East Home Street Westerville, Ohio 43081 f: 614.891.4200

614.891.2020 bts_ jks@msn.com

Office Use Only

FILE # ____________

VERTICAL ____ FULL-LENGTH ___

HORIZONTAL ____ CLOSE-UP ____

MAIN COLLAGE IMAGE _____________

Office Use Only

POSE ______ of ______

COSTUME COLOR/DESCRIPTION

__________________ COLOR ____ B&W ____

PARENT SPECIAL REQUEST:

__________________

ONE FORM PER POSEIf ordering from multiple costumes, you’ll need one ORDER FORM for each costume with Student’s Name on each

Please fill out all information necessary BEFORE ARRIVAL . . . Credit Card information only necessary on FIRST ORDER FORM

PACKAGESEach Individual Package Unit = $25 (One Pose)

***Buy 3 Package Units of Same Pose and RECEIVE a 4TH UNIT OR Digital Image FREE ***

11 33 4422 55QUANTITY ITEM# ITEM DESCRIPTION PRICE AMOUNT

_________ 1) One 8x10 Photograph $25 _________

_________ 2) Two 5x7 Photographs (One Pose) $25 _________

_________ 3) Two 4x6 Photographs (One Pose) $25 _________

_________ 4) Four 3½x5 Photographs (One Pose) $25 _________

_________ 5) Eight Die-Cut Wallets Photographs (One Pose) $25 _________

_________ 6) Add Facial Retouching Only to One Pose - Per Head $20 _________

_________ 7) One Hi-Res Image emailed to: $49 _________

GENERAL INFORMATION:Dancer’s Name:

Parent Name for Shipping:

Shipping Address:

City:

State: Zip:

Mom’s Cell Phone:

( )Mom’s Email: TOTAL ORDER $

CASH ______ M/O or CHECK # _______ Please make checks payable to: Creative Moments

Sorry, change will be unavailable. A service charge of $35 will apply to all returned checks.Write one check to cover all orders . . . Ohio State Sales Tax is already included in pricing.

ACCT. #____________________________________________________________________

Qty. Item # Size Item Description Price____ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ____________ ______ ______ _________________________________ ________

ORDER INFORMATION FOR ONE COSTUME ONLY:

PLEASE PRINT CLEARLY ALL ITEMS MUST BE ORDERED AND PAIDPRIOR TO BEING PHOTOGRAPHED

Monday, Tuesday, Wednesday June 1, 2, 3 @ NDA - Open to Dancers with One Outfit at a Time (may change in car or go home to return in line again same day IF desiring a Multi-Pose Order) Enter via NDA Side Door to Hall w/Judith to finalize Order Form(s) . . . then to Studio A - 6 ft. spacing required - 1 Dancer w/1 Adult only admitted)

No Appointment Necessary 1:00-7:30 pm each day (arrive dressed and ready - no changing rooms/restrooms available)

Thursday, Friday, Saturday June 4, 5, 6 - Open by Appointment ONLY - 1 Dancer w/1 Adult Only for Multi-Pose Orders and/or Multi-Costume Change Dancers (w/Private Dressing RoomS & Restroom available) at

CREATIVE MOMENTS PHOTOGRAPHY 131 East Home Street Westerville, Ohio 43081

SHIPPING AUTOMATICALLY ADDED FOR IMAGES PHOTOGRAPHED AT NDA $10.00

EXP. DATE ___________ CV V CODE __________ ADDRESS NUMBER ASSOC. W/CREDIT CARD____________ ZIP CODE ____________

NDA 20202020 BACKGROUND IS GREYFor those ordering a Collage, please mark preference of: WHITE ________ GREY _________

10” 14” 20” _________ 11) Single Full-Length Statuette $ 50 _______ $ 75 _______ $100 ________________ * 12) Double Full-Length Statuette $ 75 _______ $100 _______ $125 ________________ * 13) Triple Full-Length Statuette $100 _______ $125 _______ $150 _______ _________ * 14) Quad Full-Length Statuette $125 _______ $150 _______ $175 _______ _________ * 15) Five Person Full-Length Statuette $145 _______ $170 _______ $195 _______ _________ * 16) Six Person Full-Length Statuette $165 _______ $190 _______ $215 _______ _________ * 17) Seven Person Full-Length Statuette $185 _______ $210 _______ $235 ________________ * 18) Eight Person Full-Length Statuette $205 _______ $230 _______ $255 _______

Full-length ACRYLIC ONE PERSON STATUETTES - Add sibling at $10 per pose#11 #17#13 #15

QTY. DESCRIPTION H or V PRICE AMOUNT____ __________________________________________ _______ _______ __________

____ __________________________________________ _______ _______ __________

____ __________________________________________ _______ _______ __________

____ __________________________________________ _______ _______ __________

____ __________________________________________ _______ _______ __________

4X6 INDIVIDUAL PHOTO IN “FANCY THAT” FRAME $40MATCHING BOW INCLUDED ~ Easel Back AND a hanger! ~ Magnets extra

Please write in your frame & add-on magnet selections from display

Add-on Letters, Words,Flowers, & Extra Bows

to “Fancy That” FramesLetter Magnets $3 eaWord & Flower Magnets $5 eaExtra Bow Magnets $7 ea

“Tan VintageDamask”

“Pink/Chocolate Dot”

“Zebra Print”

“Pink Glitter”

“White Striated”

CHOOSE FROM:CHOOSE FROM: Black, White, Gold, Black, White, Gold, Black w/ Gold Lip, Black w/ Gold Lip, Modern Oak & Ranch Oak

Modern Oak & Ranch Oak

ADD ON MOREADD ON MORE

EACH YEAR!EACH YEAR!

CLUSTER FRAME WITH PHOTO INCLUDED

QTY. DESCRIPTION PRICE AMT. ____ 19) 4x6 Photo In Cluster Frame $40 _________ 20) 5x7 Photo in Cluster Frame $50 _________ 21) 8x10 Photo in Cluster Frame $60 _____

Clips Included

“Black/White Dot”“Turquoise Glitter”

“Lime Green Glitter”

“Black Damask”

“Cream Striated”

SINGLE POSE GLOSSY WOOD PLAQUES

QTY. ITEM# DESCRIPTION PRICE AMOUNT

________ 8) One 5x7 Single Pose Photograph On Glossy Plaque $45 ea. _________

________ 9) One 8x10 Single Pose Photograph On Glossy Plaque $60 ea. _________

10)

QTY. ITEM# DESCRIPTION PRICE AMOUNT ______ - One Large Image with Up to Five Additional Images $ 95 $140 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $105 $150 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $115 $160 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $125 $175 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $150 $200 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $175 $225 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $250 $300 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

______ - One Large Image with Up to Five Additional Images $350 $400 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N N/C N/C

Up to Three OutfitsUp to Six Poses

Up to Six OutfitsUp to Six Poses* 33) 8x8 (with easel back) Up to 6 Image Digital Collage

* 34) 8x10 (with easel back) Up to 6 Image Digital Collage

QTY. ITEM# DESCRIPTION BASE PRICE ADD RETOUCH ADD SMOKE TOTAL AMOUNT____ 22) 5x7 Art-Board Mounted Photograph $ 35 $ 50 $100 _________ ____ 23) 8x8 Art-Board Mounted Photograph $ 45 $ 50 $100 _____________ 24) 8x10 Art-Board Mounted Photograph $ 65 $ 50 $100 _____________ 25) 10x10 Art-Board Mounted Photograph $ 85 $ 50 $100 _____________ 26) 12x12 Art-Board Mounted Photograph $105 $ 50 $100 _____________ 27) 11x14 Art-Board Mounted Photograph $125 $ 50 $100 _____________ 28) Up to a 16” Art-Board Mounted Photograph $150 $ 50 $100 _____________ 29) Up to a 20” Art-Board Mounted Photograph $200 $ 50 $100 _____________ 30) Up to a 24” Art-Board Mounted Photograph $300 $ 50 $100 _____________ 31) Up to a 30” Art-Board Mounted Photograph $425 $ 50 $100 _____________ 32) Up to a 40” Art-Board Mounted Photograph $550 $ 50 $100 _________

* 35) 10x10 (with easel back) Up to 6 Image Digital Collage

* 36) 11x14 (with easel back) Up to 6 Image Digital Collage

* 37) 12x12 (with easel back) Up to 6 Image Digital Collage

* 38) 10x20 (no easel back) Up to 6 Image Digital Collage

MOUNTED SINGLE POSE ART IMAGES

MOUNTED MULTI-POSE ART COLLAGES on Black Board - Add sibling at $10 per pose

# QTY. SIZE DESCRIPTION PRICE ADD A REAR PHOTO TOTAL OF BOTH41) _____ 4x6 Single Pose Photo in Acrylic Block $ 65 _______ *2nd Single Pose in Photo on Rear $ 80

42) _____ 5x7 Single Pose Photo in Acrylic Block $ 90 _______ *2nd Single Pose in Photo on Rear $115

43) _____ 10x10 Single Pose Photo in Acrylic Block $135 _______ *2nd Single Pose in Photo on Rear $175

MULTIPLE POSE COLLAGE IN A CUSTOM ACRYLIC BLOCK MAGNETIC FRAME 46)

44)_____ *10x10 ______ (Front Side Only) $200 $255 _________ First Name on Image? (Please Print) _______________________ 2020 Year ____ Y ____ N

ACRYLIC BLOCK CUSTOM MAGNETIC FRAMES WITH PHOTOGRAPH

*39) 16x16 (no easel back) Up to 6 Image Digital Collage

Up to Three OutfitsUp to Six Poses

Up to Six OutfitsUp to Six Poses

AMOUNT

*40) 16x24 (no easel back) Up to 6 Image Digital Collage

QTY. ITEM# DESCRIPTION PRICE AMT. ____ 48) 4”x5” Photo Magnet $ 20 _________ 49) 3” Photo Button $ 15 _________ 50) 3” Photo Mirror $ 15 _________ 51) 3” Photo Magnet $ 15 _________ 52) Large Acrylic Photo Keychain $ 20 _________ 53) Chrome Metal Photo Keychain $ 30 _________ **54) Two 2”x3½” Bag Tags (2 lines /28 ch.) $ 20 _____ _____________________________________ _________________________________________ 55) Three PVC 1”x2” Key Fobs $ 15 _________ 56) Small Acrylic Photo Keychain $ 15 _________ 57) Metal Photo Dog Tag Necklace w/ Chain $ 25 _________ 58) Photo Neoprene Mouse Pad $ 30 _________ **59) 8x10 Calendar Photo Magnet (1 line / 30 ch.)$ 35 _____ _____________________________________

PHOTO A LA CARTE ITEMS & GIFT ORNAMENTS

QTY. ITEM# DESCRIPTION PRICE AMT.____ 60) 4”x10” Dry Erase Board Locker Magnet w/Marker $ 25 _________ 61) Square 1.5” Pearl Photo Necklace w/Black Braided Cord $ 45 _________ 62) Emma 1.25” Square Antiqued Pewter Photo Necklace $110 _________ 63) Grace 1”x1.5” Rectangle Antiqued Pewter Photo Necklace$125 _________ 64) 2.75” x 2.75” Round Porcelain Photo Ornament $ 40 _________ 65) 3.5” x 5” Oval Acrylic Ornament $ 35 _________ 66) 3” x 3” Apex Metal “Unique Edges” Photo Ornament $ 40 _________ 67) 4” x 2.9” Posh Metal “Unique Edges’ Ornament (H) $ 45 _________ 68) 4” x 3” Posh Wood “Unique Edges” Ornament (H) $ 45 _________ 69) 2.75” x 3.75” Oval Frosted Glass Lightcatcher (V) $ 50 _____

* Multiple order forms required for number of Costumes

** Personalization included. Number of lines and characters as noted.

** #59 #60 #61#62

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#51#48 #52 #53

** #54#56#55 #57

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A LA CARTE FRAMES ONLY - No Images Included

QTY. ITEM# DESCRIPTION PRICE AMOUNT______ 45) 4x6 “Fancy That” Fun Frame with Bow, Bedazzled, Metal or Wood Easel Frame or Cluster (with Clip) Frame $25 ________________ 46) 5x7 Bedazzled, Metal or Wood Easel Frame or Cluster (with Clip) Frame $35 ________________ 47) 810 Bedazzled, Metal or Wood Easel Frame or Cluster (with Clip) Frame $45 __________

Thanks so much for your order! It’s a joy to serve the NDA family and we appreciate the privilege of serving each of you!

INDIVIDUAL ORDERS take 6-8 weeks in production. Dancers photographed and placing Orders

at NorthPointe Dance Academy Studio will be subject to a $10 shipping fee.

For “Multiple-Outfit/Multiple Pose Orders” photographed at Creative Moments, those students will have

the option for choice of $10 Shipping or free pick-up by appointment at Creative Moments.

NO photographs will be available for pick-up at NDA this year.

Neither NDA nor Creative Moments will be responsible for ANY purchased photo orders not picked up prior to

October 1, 2020. Current health and safety measures will be taken into consideration, however, by visiting

either NDA or Creative Moments, guests will voluntarily assume all risks related to Covid19.

We look forward to seeing you again next year . . .

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(O)614.891.2020 bts_jks@msn.com (TEXT) 614.424.9848131 East Home Street Westerville, Ohio 43081