ORDER FORM


HalfPriceVideo.COM
2417 19th Street
Huntsville, Texas 77340

Phone Orders: 936-295-5767

FAX Orders: 936-295-0020

www.HalfPriceVideo.com
info@halfpricevideo.com

BECAUSE WE ARE A DISCOUNT EDUCATIONAL DISTRIBUTOR, PREPAID ORDERS TO U.S. DESTINATIONS ARE SHIPPED FREE OF CHARGE VIA UPS GROUND! SHIPPING AND HANDLING IS $3.00 FOR ONE VIDEO, AND $1.00 FOR EACH ADDITIONAL VIDEO.
    Date:

    Purchase Order No:

    Please charge to my credit card:

    Card Number:

    Expiration Date:

    Signature

    Phone Number:

    Fax Number:

    E-Mail Address:

BILL TO:

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    SHIP TO:

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QTY. CATALOG # VIDEO TITLE UNIT PRICE
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