Video Order Form

Please print, complete, and mail to the address at the bottom of the page.

 

 

 

 

Name

 

 

Mailing address

 

 

 

 

 

 

 

 

Email address

 

Home phone

 

 

 

 

 

 

TOTAL

 

DVD Quantity

 

X $24.95 ea =

 

 

 

VHS Quantity

 

 

X $24.95 ea =

 

 

 

 

 

Subtotal

 

 

 

(Virginia residents only;

$1.13 per item)

 

4.5 % sales tax

 

 

 

($4.00 for first item + $.50 for each add’l item)

 

Shipping & Handling

 

 

 

 

 

Order Total

 

 

 

Comments or special instructions:

 

 

 

 

 

 

 Please mail this form along with your check or money order to:

 

Reel Life Productions

1214 Heritage Commons Ct

Reston, VA 20194

 

www.wildflowermtb.com - info@wildflowermtb.com