ORDER FORM

 

 

I would like to purchase the following video(s):     1      2      3      4      5      6

(Please circle your choices.)

 

 

Your mailing address:

 

Name __________________________________________

 

Street Address ___________________________________

 

City ______________________________    State ______  Zip ________

 

Email: ________________________________

 

 

Shipping address, if different from above:

 

Name __________________________________________

 

Street Address ___________________________________

 

City ______________________________    State ______  Zip ________

 

 

 

Enclosed is my payment for $_________for the _________ video(s) circled above.  (Refer to chart below.)  You may pay by check (made payable to Jay Bartol), cash, money order, or PayPal.  No credit cards, please.

 

1 Video

2 Videos

3 Videos

4 Videos

5 Videos

6 Videos

$17

$34

$51

$68

$75

$92

 

 

Desired videotape format?  VHS (USA TV standard) or VHS PAL (European/African TV standard).  (Please circle one).

 

Mail this completed order form, together with your payment, to:

 

Jay Bartol

3709 Fort Worth Avenue

Alexandria, VA 22304-1707