VIDEO ORDER FORM
Please pay for separately
Cost: $ 35.00 includes shipping
Please allow 4 – 6 weeks for delivery
Name: ________________________________________________________________
Street: _______________________________________________________________
City: _________________________ State: _________ Zip Code: ______
Student Name: _________________________________________________________
Number of Videos: _______
Total Price: _______
Payment Method: Cash Check
________________________________________________________________________
Office Use Only
Number of Videos: _______
Total Price: _______
Payment Method: Cash Check
