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Please fill out this form completely and consider all fields as required.

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Biographical Info:

First Name:

MI:

Last Name:

Suffix:

Address 1:

Address 2:

(Include your Apartment Number here, if appropriate.)

City:

State / Province:

Country:

* Age:

D.O.B.:

Format: MM/DD/YYYY

Contact Phone:

Format:(XXX)XXX-XXXX

Best Time of day to call:

12 or 24 Hour Format

** E-Mail Address:

Tentative Event Date(s):

Format: MM/DD/YYYY-MM/DD/YYYY
Start Time-End Time 12 or 24 Hour Format

Type of Photo Shoot requested (Check all that apply):

Where did you hear about Reitz Digital Imaging?!

Please tell me which of my many ads worked?

Questions/Comments:

Feel free to comment on anything!

Account Access Info:

User Name:

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* All minors must have parental consent to shoot in writing. All consent forms and proper ID for parents and/or adult guardians must be provided prior to any shoot. There are no exceptions for minors.

** Email address is a required field. Entering an improper e-mail address will result in an error upon submission of this form.

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