ORDER FORM

MOVIE TITLE:_______________________________________

FORMAT: VHS__ DVD___

NAME____________________________________

SHIPPING ADRESS

__________________________________________________

CITY:______________________________________________

STATE:______ ZIP CODE:__________ APT NO.:_____________

HOME PHONE:________________________________________

WORK PHONE:________________________________________

Copy and Paste this order form into your E-MAIL, Fill it out completely and Mail it to me and I will send you mail back to confirm everything above and you will also be provided with a billing adress.

Sorry we do not except credit card orders.. Only CHECK OR MONEY ORDERS...

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