Order
Form
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(please
print this form from your browser and fill in appropriate information)
Enclose
a check or money order including shipping charges, or send an organization
purchase order. We also accept Visa and Mastercard by phone. Massachusetts
residents add 5% sales tax. Make checks payable and mail this form to: |
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Title(s):
_________________________________________________ _________________________________________________ _________________________________________________ |
_________________________________ |
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DVD (purchase only) |
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Purchase | |||||
PAL
(25% price increase)
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*
Fields Required for Fulfillment of Order Please
include Name, Department and Organization or Institution
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*USER
NAME (Very Important to Us) ________________________________________________
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*USER
DEPARTMENT __________________________________________
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*ORGANIZATION
______________________________________________
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*Ship
to:
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Bill to: (if different form Ship to) | |||||
*NAME __________________________________ | NAME _______________________________ | |||||
*ORGANIZATION _________________________ | ORGAN. ______________________________ | |||||
*ADDRESS ______________________________ | ADDRESS ____________________________ | |||||
________________________________________ | ______________________________________ | |||||
*Phone _______________________________ | Phone ___________________________ | |||||
*E-Mail of Orderer ___________________________________________________ |
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*E-Mail
of User ______________________________________________________
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*Sales Agreement | ||||||
We
agree that this rental or sale is for educational non-theatrical use only.
We further understand that this film or video is protected by U.S. copyright
code and under no circumstances may it be duplicated, reproduced (by vtr
or any other means), televised, put on the internet, or transmitted in whole
or in part. *Signature ______________________________________________ |