Livestream_Cooper

Congress Video Order Form

"*" indicates required fields

Name of person Placing Order*

First Last

Phone*

Email*

For the online choice this is the email address your video link will be sent to.

Address

Required if you are ordering a video that will require shipping (USB)

Street Address Address Line 2 City State ZIP Code

Congress Year*

Delivery Method*

Quantity*

Plesae indicate the number of videos you are ordering.

Please enter a number greater than or equal to 1.

USB Thumb Drive*

Price:

Name Of Rider*

First Last

Arena*

Class Type*

Pattern Class

Rail Class

Speed Class

Class Name*

Date of Ride*

Draw# or Split#

Back Number*

Additional Comments

If ordering more than 1 run at a time please be specific here. Include the Date, Name of Rider, Back #, Draw #, Arena or anything else that may help us identify the correct ride. Also be sure to increast the quantity being ordered.

Payment Method*

Only select "Cash or Check" if you are at the show and plan on paying the day you place an order online. Orders will not be processed until paid. Our booth is in the Celeste next to Shane Rux Photography.

Total

Contact

Name*
First Last
Email*
Phone*
Message*
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Congress Video Order Form

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