(Print this order form and fax or mail it to CrossWise)

Christmas Break

Video Order Form

 

Please send me ____ copies at $30 each (includes tax & delivery) Video delivery expected by mid-January, 2004.

 

Name: _______________________________________________

 

Address ______________________________________________

 

City/State/Zip _________________________________________

 

Email: _______________________________________________

 

Phone: _______________________________________________

 

Include $30 each, or fill out credit card information:

 

Name on Card: _________________________________________

 

Card Number :__________________________________________

 

Type  __ MasterCard   __ Visa  __ Discover __ American Express

 

Exp Date: ____________Signature: _________________________

 

Mail to:                   

CrossWise Productions

PO Box 4129
Dallas TX 75208

 

Or fax to:

 

972-291-3400

 


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