South Marple Little League

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South Marple Little League Active Image Media, LLC 455 Doe Run Lane Springfield, PA 19064 610.328.3456 email: [email protected] A La Carte Items can be ordered with or without a package!

Package #1 - $45.00 1 - Pagemate 1 - Magazine Cover 12 - Trading Cards 1- Photo Button “All personalized” Package #3 -$29.00 1 - Memory Mate 2 - Photo Magnets 1 - 2” Keychain Package #5 - $27.00 1- Memory Mate 12 Trading Cards Credit Card Information

Package #2 - $36.00 1 - Memory Mate 12 Trading Cards 2 - Photo Magnets

Package #4 - $25.00 1- Pagemate 2 - 5x7 Individuals 2 - Photo Magnets Package #6 - $23.00 2 - 5x7 Individuals 4 - Individual Wallets 1 - 5x7 Team Photo VISA

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Name on card _________________________________________________ Card # _____________ - _____________- _____________ - _____________ Exp Date ____________Sec. Code___________ Amount $___________ Address _________________________________________________________ Zip Code _____________ Phone #____________________________ Separate at Perforation

South Marple Little League Team and Individual Photos

Active Image Media, LLC 455 Doe Run Lane Springfield, PA 19064 610.328.3456 Athlete Information

PLEASE PRINT CLEARLY!

Athlete’s First and Last Name: __________________________________________________________________ Parent’s Names: ____________________________________email: ___________________________________ Mailing Address:______________________________________________________________________________ City:______________________________________________________ State:_________ Zip:________________ Phone: ( )_____________________________ Team:___________________________________________ Age: _________ Position:__________________________________________________ Uniform # ___________ Hometown:_____________________________________________ Coach: _____________________________________ Order Information

Check your Order Carefully!!

1. List item #, quantity, price and total in the box on right. 2. Enclose check or credit card information slip in the envelope provided. Cash is accepted but no receipts are available from the photographer.

ITEM #

QTY

PRICE

TOTAL

**Payment may be sent after picture day, however we cannot guarantee a timely delivery of your package*

Make checks payable to: Active Image Media Notes ______________________________________________________________

NOTE: Please print clearly! We will not be responsible for errors due to illegible handwriting. Thank you for your assistance!

email : [email protected]

TOTAL ENCLOSED $_______________

NOTE: Payment by check is your express authorization that any returned check may be represented to your account electronically or as an IRD along with a separate EFT or demand draft for the max returned/dishonored check fee as allowed by state law. State check fees are available at: www.statecheckfees.com or by calling 1.800.460.0124 3/15