| Name | _______________________________ |
| Mailing Address | _______________________________ |
| _______________________________ | |
| City | _______________________________ |
| State | Zip | _______________________________ |
| Email Address | _______________________________ |
| Phone 1 | _______________________________ |
| Phone 2 | _______________________________ |
| space | |
| Headshot | |
| Font Type | _______________________________ |
| Name to Appear | _______________________________ |
| Alignment | left - center - right |
| Size | Unless otherwise specified, 8 X 10 is used |
| _______________________________ | |
| space | |
| Business Card | |
| Font Type | _______________________________ |
| Name to Appear | _______________________________ |
| Other Information | _______________________________ |
| _______________________________ | |
| _______________________________ | |
| _______________________________ | |
| Alignment | left - center - right |
| Would you like a border around the Picture ? | Yes - No |
| space | |
| Would like an Email before continuing | Yes - No |
| Would you like to be listed in http://geocities.com/ActorHeadshot | Yes - No |
|
Please Note: http://geocities.com/ActorHeadshot is a free service to all subscribers. Your Web Address will be http://geocities.com/ActorHeadshot/your_name Please circle where applicable, and any information not listed will delay your processing. For best results, please have the photo to be used in black & white 8 X 10 format. Mail your black & white headshot along with payment of $29.95 plus $3.00 shipping & handling to:
Eddie Madrigal
Phone: 916-549-1835
|
