CINEFEAR VIDEO AND SOUND & VISION AUDIO AND VIDEO ORDER FORM
(FOR ORDERING BY MAIL ONLY!)


Name
Address
City
State and Zip
Phone (   )

 
TITLE PRICE
1. $
2. $
3. $
4. $
5. $
6. $
7. $
8. $
9. $
10. $
11. $
12. $
All checks and money orders made payable to: SUBTOTAL $
Keith J. Crocker
P.O. Box 1742
Baldwin, NY 11510
$4.50 Shipping for 1-3 video tapes, $1.50 for each additional tape. $
PLEASE SIGN THE FOLLOWING IF NEEDED:
I am 18 years of age or older
$1.50 Shipping for 1-3 audio tapes.  Large orders (four tapes or more) should add $0.50 for each additional tape. $
Name 

Date

FOREIGN ORDERS:  $10 for the first video tape, $5 for each additional tape.  $3 for the first audio tape, $1 for each additional tape. $
TOTAL $