Star Chronicles Order Form for Check or money order

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Order form for Check or Money order

Please fill out the order form below to receive your Star Chronicles DVD or Lumia Nights DVD video.
SEND
Check or Money Order (In U.S. dollars) :

Video Image Productions Inc.

8133 Jenkins Road

Winston, GA 30187

QTY		PRICE
	Select DVD	DVD $20.00
Product Cost SHIPPING U. S. Shipping $4.00 Canadian & other International Orders
U.S. Only. 2nd Day Air $14.99 first video + $3.00 each additional
TOTAL

privacy statement

First Name:		Last Name:
Company:	(if applicable)
Address 1:	Shipping (Street/UPS) address
Address 2:	Add'l (P.O. Box, 2nd add. line)
City:		State:	Zip/Postal Code:
Province:		Country:
Email:
Special Instructions or Alternate Shipping Address:

Payment

SEND
Check or Money Order (In U.S. dollars):

Video Image Productions Inc.

8133 Jenkins Road

Winston, GA 30187

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