EMPIRE 2018 VIDEO ORDER FORM
Email address *
CONTACT INFORMATION
DANCER'S NAME *
Your answer
CELL PHONE NUMBER *
Your answer
EMAIL ADDRESS *
Your answer
DANCE ORDER INFORMATION
MAN'S NUMBER *
Please make your number visible to the camera's. If dancing with multiple partners must submit 2 order forms.
Your answer
DRESS COLOR *
Please give us your dress color/description. If multiple dresses, please specify.
Your answer
HEAT NUMBERS *
USE SEMICOLONS to separate your heat numbers. Specify if the heat is Quarters, Semi, Final, Pro Heat or a Solo. If order is NOT specified all call backs will be recorded. All Sales Final.
Your answer
CHOOSE YOUR FORMAT *
In what format do you want your video delivered?
Required
PRICE CATEGORIES *
Please select the category for your order. Select all that applies.
Required
Payment
Please double check all of your information is correct.
Cash payment is also available.
Credit Card #
Your answer
EXP Date
Your answer
CVC #
Your answer
Zipcode
Your answer
All Callbacks $15
I understand that by placing this order, I agree to charges from TV Dance. I also understand TV DANCE is NOT RESPONSIBLE FOR HEATS ENTERED INCORRECTLY OR MISSED DUE TO BEING COMBINED OR MOVED FROM ORDER. *
You are all set! All orders are processed in the order they are received. We will TEXT you when your order is ready. Thank you!
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