Payment Plan & Order Form

CLIENT INFORMATION

Name

First Name

Last Name

Session Date

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Package/A La Carte Items Purchased

Form of payment

Credit

Payment Plan

Cash

Check

Gift Card

Special Discounts

OK Tax

$

Total Due

$

30% Down (Payment Plans Only)

$

Payment Dates

Product Image numbers

Client Initials

Additional Notes