“ROGERSFLEXWORLD”

Video Tape Order Form

Name: _________________________________________________________________

Address: _______________________________________________________________

City: _____________________________________ State: _________ Zip:________

Phone: ( ___ ) _____________________ E-mail: _____________________________

Orders can be made by:

1. Filling out form along with a money order, cashiers check, or personal check in U.S. dollars only.

2. With credit card or email total amount through PayPal.

Videos Ordered:

Quantity: ____ Video_____________ VHS TAPE NTSC_____

DVD NTSC_____($5.00 extra for DVD)

Quantity: ____ Video_____________ VHS TAPE NTSC_____

DVD NTSC_____($5.00 extra for DVD)

Quantity: ____ Video_____________ VHS TAPE NTSC_____

DVD NTSC_____($5.00 extra for DVD)

Shipping Charges:

All orders shipped First Class mail.
 

Mail Order Form To:

Roger Sherman

1649 Washburn Ave, Corona, California, 92882