Customer Info:
Name: 
Address: 
City: 
  State:   Zip: 
Home Phone: 
  Other Phone: 
Email: 
Shipping Info :
   
Check if shipping address is same as address above
   
I'll pick up my order
Name: 
Address: 
City: 
  State:   Zip: 
Home Phone: 
  Other Phone: 
How soon do you need your order?
 
   Standard turnaround time (within 2 weeks of receiving order)
   Rush service (please contact for detailed pricing)
  I need the order in my hands by this date: 
How did you hear about Your Life Digital?
 
   Family member or friend    Google or other search engine
   Stumble Upon    Brochure or other advertisement
  Other: 
Mailing List :
Would you like to be added to our mailing list? Your email will never be given out to any other parties or services. Members of this list will receive exclusive offers and product information through email on a monthly basis.
Yes     No                    
Marketing :
Do we have permission to use your final slideshow as a part of our marketing efforts? This includes any still images or video found on our website, flyers, or other advertisements.
Yes     No                    
Additional
Comments or
Questions :