Jorge Visions Video & D.J. Productions

253 North Applegate Road, Ithaca, NY 14850
(607) 256 - 4106        Jorge@htva.net
www.JorgeVisions.com

This is a contract of obligation between Jorge T. Cuevas, on behalf of Jorge Visions
Video & D.J. Productions and:
(please print your name(s), address, & phone #s, & e-mail below)
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_____________________________________________________________
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to do business as stated in this agreement.

Date                 Time range                    Location (Directions, maps, & contact phone#)
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Type of services provided____________________________________________
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Other special arrangements__________________________________________
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Cost plus tax $ _________________________________________________

Deposit $ ______________________________________________________

(Non-refundable, but applied towards total cost)

Balance due $ ___________________________________________________
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Your signature(s):_________________________________________________
Service provider:__________________________________________________