|
No. Copies |
TITLE |
DVD (circle format choice) |
| _____ | THE PERMEABLE MAN | $14.95 |
PLEASE ADD $3.95 FOR SHIPPING AND HANDLING (overseas order will be charged more)
BILLING ADDRESS:
Name ____________________________________________________
Address 1 _________________________________________________
Address 2 _________________________________________________
City___________________________ State ______ Zip _____________
Email Address:
________________________________
Phone Number ________________________________
Cell Phone ___________________________
PAYMENT TYPE:
BY CHECK:
Personal or cashier’s check accepted via regular Mai
BY CREDIT CARD (via Mail or fax):
Card Type: VISA
MASTERCARD AMEX
DISCOVER
Credit Card Number:
________________________________________
Exp Date _________________________________
Name on Card: ______________________________________________
SHIPPING INFO (If different than above)
Name ____________________________________________________
Address 1 _________________________________________________
Address 2 _________________________________________________
City___________________________ State ______ Zip _____________
When you have completed filling in this form, you can
FAX IT: 1 (309) 423-8980
Or Mail it to us at
Reel Jewish Entertainment
1512 Murray Ave
Pittsburgh, PA 15217