| 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
|
$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 | $ |