VIDEOTAPE/DVD ORDER FORM

To order by fax or post, please print out and complete this form and fax to 510-658-1583, or Mail to:

Bonnie Burt Productions
958 Rose Avenue
Piedmont, CA 94611

Order Information:

Number to Order:

Movie Title:

Unit Cost:

Shipping & Handling:

Total:

         
         
         
         
         

Total to pay:

 

Customer Information:

Name:

 

Address:

 

City, State, Zip Code:

 

Country:

 

Phone:

 

Fax:

 

Email:

 

Purchase Order # (if any):

 

Comments:

 
 

Credit Card Information (please circle type of card):

Credit Card type:

VISA / MASTERCARD / OTHER (specify)

Card Number:

 

Expiration Date:

 

Do you wish to receive any emails from us about future movies (we do not share emails with other organizations)?  YES/NO