450 E. 8th St. Douglas AZ 85607
Phone/Fax
520-805-1850
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: 520-805-1850
1. Print
out this form
2. Fill it out
3. Make check or money order to: Harrod Blank
4. Mail to: Camera Van, 450 E. 8th St. Douglas, AZ 85607
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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