Name *

First Name

Last Name

Phone *

The best number to reach you.

(###)

###

####

Dance Date *

MM

DD

YYYY

Would you like to be a Pick-Up House? *

Pick-Up Houses allow me to service ANY school in Chicagoland. I'll give you a $1 credit for each order picked up from your home as a thank you that can be used on your kid's order or any future order with me. What do you have to do? Be home at a time designated by you, and collect envelopes of exact payments. That's all! I'll take care of informing everyone of your address and pick up time.

No thanks!

Sure I'll do it! (enter your address below)

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pick Up Date *

MM

DD

YYYY

Approximate Pick Up Time *

This can be changed later, if needed.

Hour

Minute

Second

AM PM

Jewelry *

So I know what accent metal to use.

Silver-backed Rhinestone

Gold-backed Rhinestone

Pearl

OTHER

Upgrade corsage?

See descriptions above.

Deluxe - add $10

Bling - add $10

Pearl Bracelet - add $15

Rhinestone Bracelet - add $15

Upgrade boutonniere?

See descriptions above.

Deluxe - add $5

Bling - add $10

How would you like to pay? *

10% sales tax will be added to each order. Please select one.

Cash at Pick Up

Check written out to M. Carnagio Designs, Inc.

Credit Card (you will receive a link e-mail via Square to pay)