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Video and Limited Edition Print Series I
Order Form
| Quantity |
Title
|
Unit Price |
Total |
|
Video - DVD
|
$ 25.00
|
$ |
|
Video - VHS
|
$ 25.00
|
$ |
|
Name of Print
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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
|
$ |
|
Write the Special Code here >
for a 10% discount
|
- $ |
|
|
Sub-total
|
$ |
VA residents add
5% sales tax
|
$ |
shipping
(see below)
|
$ |
|
Total
|
$ |
Include your name and address in the space above.
Shipping: allow 4 weeks for delivery
| Prints: |
$ 8.00 for first item
add $ 2.00 for each
additional print |
Circle one Visa MC |
| Video |
$ 5.00 for one item
add $ 3.00 for each
additional video |
Credit Card # _________________________________________ |
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Expiration Date (00/00) / |
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Zip Code (that matches the billing address of the card) ___________ |
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Signature |
Please print this form and mail it with your credit card information or with a check made out to:
Virginia Lloyd-Davies, 366 Mackeys Lane, Fairfield, VA 24435
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