Excentrix@aol.com
2248 Summer St
Berkeley CA 94709-1438
510-841-4128 voice 510-845-0641fax

TO ORDER BY CHECK OR MONEY ORDER WITHIN THE USA ONLY
FOR ORDERS OUTSIDE THE USA:
If you prefer not to pay using a credit card please inquire by email or telephone: 510-841-4128

1. Print out this form
2. Fill it out
3. Make check or money order to: Harrod Blank
4. Mail to: Camera Van, 2248 Summer St., Berkeley CA 94709 -1438
All of your personal information is strictly confidential and will not be sold nor shared with anyone for any reason.

Price / Qty. Title

______/_____WILD WHEELS DVD VIDEO
$29.95 Plus Shipping and Handling

_____/_____WILD WHEELS VIDEO - VHS FORMAT
$20.00 Plus Shipping and Handling

______/_____WILD WHEELS VIDEO - PAL FORMAT
$30.00 Plus Shipping and Handling


______/_____DRIVING THE DREAM VIDEO - VHS FORMAT
$20.00 Plus Shipping and Handling


______/_____DRIVING THE DREAM - PAL FORMAT
$30.00 Plus Shipping and Handling

______/_____20 ART CAR POSTCARDS
$8.95 Plus Shipping and Handling


______/_____5 CAMERA VAN POSTCARDS
$5.00 Plus Shipping and Handling


______/_____WILD WHEELS BOOK
$18.95 Plus Shipping and Handling


______/_____IN THE LAND OF THE OWL TURDS VIDEO - VHS FORMAT
$20.00 Plus Shipping and Handling


______/_____12 - 2" ART CAR STICKERS
$2.25 Per Sheet (no shipping applies if you are only purchasing stickers)

____________SUBTOTAL

____________TAX   California residents only please add 7.25% CA sales tax.

       $5.00          ADD $5.00 FOR SHIPPING AND HANDLING WITHIN THE USA

$___________TOTAL


PURCHASER INFORMATION:

Name:_______________________________________________________

Address:_____________________________________________________

____________________________________________________________

City: ________________________ State:____________ Zip:____________

Email:________________________________________________________

Phone Number (optional):_________________________________________

MAILING ADDRESS IF DIFFERENT FROM ABOVE:

Name:_______________________________________________________

Address:_____________________________________________________

City: ________________________ State:____________ Zip:____________

 

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Contact:
Harrod Blank
Berkeley, CA

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by Harrod Blank
1999. Do not
use anything
without prior
permission.
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