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* 1. Purchaser's Email Address
Please provide the email address used to place the order.

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* 2. Order Number

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* 3. Who is the video for?
Please provide us with the child's name. 

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* 4. What is the occasion?

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* 5. What is the date of the occasion? 

Date

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* 6. What special details would you like included in the video?

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* 7. What email address should we send the video to?

T