Name : Childs Name E-mail Address: * Email Confirmation Street Address City State Zip Phone Pageant Name and Date: Additional Comments Description of child and clothing in all events: Total Due My payment will be be sent Through Paypal to bellevisage1@aol.com Please add 4% to your total due if using PayPal. By money order to : Belle Visage Photography 370 Oakley Drive #516 Nashville, TN 37211 Signature & Date * Required

Colleen & Sean Charlton
(225) 266-5060

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