"*" indicates required fields Name* First Last Email* Phone*Phone (Other)Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code For the Quinceañera Ceremony of (Honoree's First/Last Name)* Date of Ceremony* Month Day Year Time of Ceremony* Hours : Minutes AM PM AM/PM Ceremony Location* Ceremony Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact Person* First Last Contact Phone*Contact Email Attire Requested for Officiant Black Suit Black Dress Robe with Cross Robe without Cross Tuxedo Other Other Attire for Officiant Please describe the attire you would like the Officiant to wear. Your Assigned LoveNotes Officiant*Marty YounkinCarol SageBarron BellKen ByrdBrian DayFrank DeLeoRandy DickenThomas GreenBritt LesleyBuster NoahMike RyherdTony SancheloKen SavageChuck SisnerosAnne SlagelChris SuttonAshley TamburinAl TaylorCharley TaylorFees and Payment Schedule Mark all applicable fees. Retainer Fees are non-refundable.Quinceañera Fee* Quinceanera ($350) – Retainer Fee ($100) Balance ($250) Trip Fees (outside Collin, Dallas, Denton, Rockwall and Tarrant Counties) Ceremony Trip Fee ($50-$150) Discuss trip fee with Minister as fee depends on distance.NOTE: Please contact us immediately if there are any changes in ceremony times or locations, as this may determine whether your assigned LoveNotes Minister is still available. Balance may be paid directly to Minister at event. Please pay your retainer fee by Credit Card or PayPal on the next page. Special Notes/Instructions for MinisterConsent* I accept the terms of the LoveNotes DFW Clergy Services Quinceanera Ceremony Agreement and will remit Retainer Fee to LoveNotes.*Signature* DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.Total Retainer Fee Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Please click the Submit button only ONE time. It will charge multiple deposits if you click multiple times.