Printer Friendly Order Form

For best results, set your browser to VIEW, TEXT SIZE, MEDIUM before printing this page. If you don't have a printer, handwrite the information on a plain sheet of paper.
Previous Page

Name (please print):________________________________________________________________________

Address:_________________________________________________________________________________

City:__________________________________________State/Province:______________________________

Postal Zip Code:________________________ Country:____________________________________________

Phone/E-mail:___________________________________________________________ (in case of questions)

Please select either DVD or VHS Tape. If neither box is checked, DVD will be shipped.

Product Code

 Product Title

DVD

VHS

Item Price

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBTOTAL

$

California Residents Only, add 8.5% sales tax

 

REGULAR SHIPPING: $3 per video in USA; $4 per video Int'l

 

EXPRESS SHIPPING: + Extra $25

 

TOTAL

$

 PAYMENT METHOD

  __VISA     __MasterCard  __American Express   __Discover/Novus    __Money Order/Check     __Cash (certified please)

  ACCOUNT  NUMBER: _________________|__________________|___________________|_________________

  EXP. DATE  ___________/___________ (Mo./Yr.)

  SIGNATURE:__________________________________________________________
                         I certify I am an adult, at least 18 years or older.

Previous PageNext Page mail with payment to:

USA Publications
P.O. Box 66734
Los Angeles, CA 90066, USA