LDS Video FAX Order Form

LDS Video: FAX-Only Order Form

We welcome orders submitted via FAX. You may print out this order form, fill it in by hand or using a typewriter, or download the form (save it to your computer) and fill in the blanks by opening the file in a word processor. Then FAX the form to:
1-480-839-1403

We will ship your order within 24 hours. You will receive a printed receipt with your order.

List the items you are ordering in the space below.
Please specify FORMAT (VHS/video, DVD, CD, book).

Name: __________________________________

FAX number: ____________________________

Telephone number (optional): ______________

email address (optional): __________________

Shipping address:

________________________________________

________________________________________

________________________________________

Billing address (if different):

________________________________________

________________________________________

________________________________________

Additional Instructions:

Payment

Credit Card (circle one):
Visa | MasterCard | American Express | Discover | Diner's Club

Card #: __________________________________ Exp.: ____/____
or call me for Credit Card number at Phone #: __________________

OR: Western Union Money Transfer Control #: _____________________________

OR: PayPal email address: _______________________________________

Shipping Method (circle one):
Regular USPS/U.S. Postal Service ($2.25+) | USPS Priority ($4.45+) | USPS Express ($14.50+)
FedEx Economy | FedEx Priority | UPS Ground | DHL Ground

For more information see: http://www.ldsvideo.com
Feel free to send us a message at the FAX number shown above.