California Aircheck Individual Tape Order Form

Print the this form and Fax  to (904) 548-9846 or Mail to: 85478 Sagaponack Drive - Fernandina Beach, FL 32034....You may pay for orders by check, money order, or credit card....
Be sure to fill out the address information below!
 

VIDEO AIRCHECK /Tape Numbers_________________________________________ $_________

Overseas VIDEO orders - Specify whether you want PAL or NTSC videos!
Overseas Orders - Add  $5.00 US Per Videotape for Airmail Shipping
 
TOTAL...................................................................................................................................................$_________
 
COMPLETE THIS ADDRESS INFORMATION FOR ALL ORDERS
Ship Order to------Name__________________________________________________________
Address________________________________________________________
City,State,Zip________________________________________________________
..........................................................................................................................................................................................

Credit Card Orders..[ ] Visa ...[ ] Mastercard ...

Name as it Appears on Card__________________________Sec. code from rear of card_____
 
Card Number______________________________________Exp Date_______________
 
E-mail address_____________________________ Amount to be Charged____________
 
Signature____________________________Phone number________________________

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If you have any questions, please contact us at georgej@californiaaircheck.com