|
Order DVD/Video |
DVD#'s _______ Video Name __________________ |
|
Name & Date |
_____________________________ ____/____/____ |
|
Phone |
area code ( _____ ) ____________________________ |
|
Address |
____________________________________________ |
|
City |
____________________________________________ |
|
State & Zip Code |
____________________________________________ |
|
Payment Type |
Check _ Money Order _ Visa _ M/C _ AmEx _ Disc |
|
CC # |
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ |
|
Expiration Date |
______ / ______ Signature ___________________ |
|
Total Enclosed |
Sub-total
......................................................$ _______
Shipping & Handling total fee (see above)..... $
_______
TOTAL
....................................................... $ _______ |