ORDER FORM
   

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We Accept:

Shipping Information:   Credit Card Information:

* = Required

  

* = Required
 * First Name:  

* Is the shipping name and address the same as the credit card billing name and address?

 Yes
No
  * Last Name:  
*  Address 1:   If the answer above is NO, please fill out billing information below:
Address 2:   *  Billing Name:
*  City:   *  Billing Address1:
*  State:   Billing Address2:
* Country      
*  ZIP   *  Billing City/State/Country:
      *  Billing ZIP
     
     
*  E-Mail Address:      
    *  Credit Card Type:
      * Credit Card Number:  
      * Credit Card Expiration:
         

ITEMS ORDERED:
         
ITEM NUMBER CATALOG NUMBER
(Must be entered with following format: H-01N)		 PRICE DVD TAPE
Note:  not available in PAL format  
1    
2    
3    
4    
5    
6    
Please add the total of all the prices:

 

    

If total is less than $75.00, add $5.95 shipping:

 

    
ORDER GRAND TOTAL:

 

    
Special Instructions/Requests:
   

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Please review order, then press Submit to send order to Confirmation Page

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 Page last revised on Tuesday September 11, 2007