Reserve Date and TIme

Reserve Your 2010 Valentines Day Ceremony Time
You can also call (937) 236-3363

In my efforts to provide you the best possible service, please complete all sections.

Who Do I Contact:

Contact Bride By telephone By E-mail

Contact Groom By telephone By E-mail

Best Time
(m-f after 5)

Brides Information:

Name:

Address:

City:

State, Zip:

County:

Telephone:

E-mail:

Military:

Branch

Status:

Date of Birth:

Previously Married: Yes No If yes, how many times?

Grooms Information:

Name:

Address:

City:

State, Zip:

County

Telephone:

E-mail:

Military

Branch:

Status:

Date of Birth:

Previously Married: Yes No If yes, how many times?

Ceremony Date/Time: February 14, 2010

Options:
Option one: (Couple Only + 2 guest) $175.00
Option two: (Couple + up to 12 guest) - $225.00

Marriage License County:

Type of Ceremony

Are you exchanging rings
Yes No

Sand Ceremony or Unity Candle
Add $35/00 - We provide - You keep
Add $35/00
Add $35/00 - We provide - You keep

Method of Payment

Must be paid in full at time of booking.
Fees Are Non-Refundable

Additional Comments:

You will be directed to the payment center when you click submit
You will contacted upon receipt of payment for additional information
concerning your ceremony.

Contact Bride	By telephone By E-mail
Contact Groom	By telephone By E-mail
Best Time (m-f after 5)

Name:
Address:
City:
State, Zip:
County:
Telephone:
E-mail:
Military:
Branch
Status:

Date of Birth:
Previously Married:	Yes No	If yes, how many times?

Ceremony Date/Time: February 14, 2010
Options: Option one: (Couple Only + 2 guest) $175.00 Option two: (Couple + up to 12 guest) - $225.00
Marriage License County:
Type of Ceremony
Are you exchanging rings	Yes No
Sand Ceremony or Unity Candle *Add $35/00 - We provide - You keep*	Add $35/00 *Add $35/00 - We provide - You keep*
Method of Payment Must be paid in full at time of booking. Fees Are Non-Refundable