Verge Video Productions   6915 Thrasher Drive - Tampa, FL 33610

Navarasa Performing Arts Academy

Video/Photo Order Form

Price: Video=$35.00; Photo=$25.00; Both =$50.00

Name    ______________________

Address ______________________

                 ______________________

Phone _______________________

Email _______________________

# of Video DVDs @ $35.00ea.____

# of Photo Discs @ $25.00ea.____

# of Photo + Video@ $50.00ea.____

___ Check here if you wish to pick up your purchase at the studio.

____ Check here and add $5.00 to have your purchase mailed.

  Total Enclosed $     ______  

Check #_______       Cash____

                                                                          (Sales Agentís Initials)

Make checks payable to: Verge Video Productions.