Payment Form
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Name
*
First
Last
Email
*
Phone
*
Date of Event
*
Location of Event
*
Selected Rental (If more than one, please put in comments)
*
Pearl Photo Booth
Icon Photo Booth
360 Photo Booth
Flower Wall
Uplighting
Centerpieces
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
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Connecticut
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District of Columbia
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Louisiana
Maine
Maryland
Massachusetts
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Montana
Nebraska
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New Hampshire
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New York
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Ohio
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Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Retainer Payment (Y/N)
*
Yes, I am paying my retainer now
No
Total Amount
$0.00
Credit/Debit Card
*
Card
Name on Card
Comment or Message
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