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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