Application for Model Web Page
Mail to: PhillyFaces.com
Church Street Studios LLC
3019 Midvale Avenue
Philadelphia, PA 19129

phone: 215.627.2420 - fax: 215-627-9720 - mail@PhillyFaces.com

Full name:

Address:
 _________________________________________________________________________

_________________________________________________________________________
city_________________________________________state________zip_____________
Phone(s):

E-mail:
 home________________work__________________cell___________________

_______________________________________________
Your name exactly as you want it to appear on www.PhillyFaces.com: __________________________________ (please print)

Check appropriate blanks and add up the total cost:
__ One year basic model listing (includes one photo, contact info, & stats), (a) minus $30 discount off initial $40 set-up fee if photography by Joe Chielli, OR $ 45.00
or
  (b) including standard set-up fee if photography is not by Joe Chielli - $75: $_____

__
Additional photos @ $25 1st additional photo, plus $15 each X _____ more photos (write in number of additional photos and multiply the cost)
$______
__ Scan fees (if images are not supplied digitally) - $9 per scan X______ = $______
__ Resumé, one page - (a) printed copy, 12 pt. type or larger, or (b) supplied by compatible computer disk or e-mail attachment - $25 $______
__ Web video clip (includes video shoot with Joe Chielli) - $195 $______
...(Make check payable to PhillyFaces.com).........................Total >>>> $______

Information for your MODEL web page
If you are represented by an agency or manager:
 Name of your agency/manager:
 _______________________________________________________
 Phone number of agency/manager: ______________________
 E-mail address of agency/manager: ______________________
 
If you are an independent:
 Your phone number: ______________________
 Your e-mail address: ______________________

Union Status:
___ I am non-union, OR.
___ I am a member of the following union(s):
 _______________________________________________________
Women Stats
Men Stats
Height: ____ Height: ____
Hair: ____ Hair: ____
Eyes: ____ Eyes: ____
Bust: ____ Shirt: ____
Waist: ____ Waist: ____
Hips: ____ Inseam: ____
Dress: ____ Suit: ____
Shoe: ____ Shoe: ____
Stats for Children
Height: ____ DOB*: ____
Size: ____ Shoe: ____
Hair: ____ Eyes: ____
*Date of Birth
Selected Photo(s) to display on my web page:
___ from my Church Street Studios proof sheet - Number of photo(s):
 (photo 1)________ ...(photo 2)________... (photo 3)________ ...(photo 4)________.
OR please select photo for me: ___

___ Selected Photo(s) to display on my web page from other source:
 (explain)________________________________________________________________________

By filling out this application, I give Church Street Studios, LLC, PhilllyFaces.com and its affiliates ("CSS") the right and permission to create and publish a web page with my name, my photo(s), and other relevant information provided on or in connection with this application, and also to display that web page on the PhillyFaces.com web site and any successor or related web sites. I agree to release, indemnify and hold harmless CSS, including all its affiliates, from any claims, loss or liability whatsoever in connection with my web page or this application.
(Please check your information; revisions incur additional charges.) - 041223

Your signature: ________________________________________________ Date: ______________