THE VIDEO FACTORY
DVD ORDER FORM
Print and mail with payment
Name:____________________________________________________
Mailing Address:____________________________________________
:____________________________________________
City:__________________________ State:_________ ZIP:_________
Telephone:_______________________________
DVD Title 1:________________________________________________
Quantity ordered:__________ Unit price:_________ Total:____________
DVD Title 2:________________________________________________
Quantity ordered:__________ Unit price:_________ Total:____________
DVD Title 3:________________________________________________
Quantity ordered:__________ Unit price:_________ Total:____________
DVD Title 4:________________________________________________
Quantity ordered:__________ Unit price:_________ Total:____________
Grand Total:____________
Make check or money order payable to: The Video Factory
Mail order to: The Video Factory; P.O. Box 11613; Fort Wayne, IN 46859
*Note: The Video Factory is not responsible for any damage to your video equipment while using our products.
Privacy Notice: The Video Factory does not release any of its customer information to third parties for the purpose of solicitation.
The Video Factory * P.O. Box 11613 * Fort Wayne, IN 46859
260-744-6511