Your Photo on any Magazine Cover - Application Form
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QuirkWorks
 245 Morsetown Rd
West Milford, NJ 07480
Tel: 973-728-7299

http://www.quirkworks.com/magazine
  • Customized just for you!
  • Professional photo editing, retouching and output!
  • Sized for 11x14" frame size - Image size for matting 8x10" ( Standard Mat opening)
  • Great gift for grads, teenagers.

Email Address: Ship To:
 (if different than Bill to)

Billing Name:

 Name:
Billing Address: Address:
City/State/Zip: City/State/Zip:
Phone: AM
Phone: PM
Child / Models Name: (print clearly):
 (to appear on magazine)
What month do want displayed?
 (to appear on magazine)
CHECK Insert "X":
Professional taken photo / school photo enclosed       Magazine Enclosed
Put me on Seventeen magazine
 $ 34.00
Put me on another magazine (add'l $20.00)
          Name of magazine:
$ 64.00
COPY Choose one:
[ ] Use standard copy on Magazine as shown ($ n/c)
          (name & month will still be yours)
$ n/c
[  ] Customized Copy* - List all copy below (add'l $24.00)
          (please use very short titles and indicate below)
 $ 24.00
Shipping & Handling (Priority USPO) $ 7.00
Please add Total Cost:
PAYMENT choose one:
[ ] Check or money order.      [ ] Pay with credit card / Paypal  Please call for instruction
*Optional - Customized Copy: 6 maximin