Code | Video Title | Language | Price | Qty. | Extended Amt |
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Shipping: Add $15.00 for first video ordered and $3.00
for each additional video | |
Total Due: | |
Print form and fill out all required information:
Company ____________________________________
Attention____________________________________
Purchase
order number _______________
Address ____________________________________
City
____________________ State _______ ZIP _________
Email
address to send receipt to _____________________________
Choose
Language: _____ English _____ Spanish
Choose
Method of Payment: __ VISA __ MasterCard
__ Money
Order Enclosed ___ Personal Check (allow 2 weeks delivery)
Credit
Card # ________________________________
Exp. Date ____/____/____ V
Code on back ___
Signature ____________________________________
Date _______________
Phone contact number ___________________
OR, mail your check
with this order to:
National Pro Clean Corp.
3355 N. Academy Blvd. Ste
271
Colorado Springs, Colorado 80917
