Welcome to Your German Video Store in the USA

This is the Mail order form if you want to Buy a Movie and will be paying by Check.

You also save 15 % of the Total Purchase price. Just deduct it form your total please.

Fill out and Print.

Send with

US POSTAL SERVICE MONEY ORDER'S & US BANK CHECKS  US Checks or CASH ONLY

To:

Video Media

P.O. Box 2203

Branson West, MO 65737

USA

S/h is: $ 6.50 per order

THIS IS THE ORDER PAGE YOU USE TO BUY A MOVIE IF YOU PAY BY CHECK OR MONEY ORDER OR CASH !

MOVIE TITLE                               PRICE                      OTY                               TOTAL

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Total Amount Due ______________

Total Payment Enclosed____________

Name______________________________________________________
Organization_________________________________________________
Street Address*_______________________________________________
City___________________________Country_________________________
State/Province_______________________Zip Code+4_______________________
Telephone: Daytime_____________________Evening_______________________