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Video and Limited Edition Print Order Form - Virginia Lloyd-Davies
November, 2004
| Quantity |
Title
|
Unit Price |
Total |
| . |
.Video - VHS |
.$20.00
|
$ |
| . |
.Video - DVD |
.$20.00
|
$ |
| . |
. |
.
|
$ |
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. |
.
|
$ |
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.
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$ |
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.
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$ |
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.
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$ |
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.
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$ |
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.
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$ |
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$ |
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.
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$ |
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$ |
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sub-total
|
$ |
VA residents add
4.5% sales tax
|
$ |
shipping
(see below)
|
$ |
|
Total
|
$ |
Include your name and address in the space above.
Shipping: allow 4-6 weeks delivery time
| Prints |
$ 8.00 for one item |
Circle one Visa MC |
|
plus $ 5.00 for each additional |
Credit Card # |
| Video |
$ 5.00 for one item |
Expiration Date (00/00) / |
|
plus $ 3.00 for each additional |
Zip Code (the one which matches the billing address of the card) ___________ |
Signature .
Please print out this form and mail or fax this page with credit card information or mail with a check made out to:
Virginia Lloyd-Davies, 366 Mackeys Lane, Fairfield, VA 24435
fax: 540-261-1935
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