Fax Form For Laserdisc Orders

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ORDER INFORMATION

School: ______________________________________ Your Name: _________________________________

Ship-To Address: ______________________________ Bill-To Address: ______________________________

City: _________________ State: ______ ZIP: _______ City: _________________ State: ______ ZIP: _______

Ship-To Attention Of: __________________________ Phone: _________________ Fax: ________________

PAYMENT TERMS

School Purchase Orders Welcome! Personal Orders Also Welcome--Personal Checks and Credit Cards Honored!

NOTE: Tax-Exempt Customers Must Present Certificate of Exemption with Order!

FOR CREDIT CARD ORDERS: _____American Express _____VISA _____Mastercard

Cardholder Name: _____________________________ Card Number: ________________________________

Billing Address: ______________________________ City: _________________ State: ______ ZIP: _______

Expiration Date: ______________________________ Cardholder Signature: ___________________________

LaserDiscs - Leading Publishers	Retail $$	Your $$	QTY	TOTAL
Dinosaurs-with LLT Multimedia Guide	100	67.95
Animals-Carnivores and Sea Mammals	100	59.95
History In Motion-WW1 to Watergate	195	69.95
For All Mankind-Apollo Lunar Missions	100	79.95
The Case of the Missing Mystery Writer	198	87.95
Art of the Western World	175	89.95
American Portfolio-Pre Columbus to 1992	198	89.95
Field Trip-Forests (Ecosystems/Biodiversity)	198	87.95
Restless Earth (Volanoes/Earthquakes)	225	119.95
Solar Systems (Astronomy)	225	99.95
Powers of the President	195	139.95
Eyes on the Prize-Civil Rights Struggle	350	199.95
Roger Wagner CD-ROM			Sub-Total
HyperStudio (Windows and Macs)	200	67.95
			Sub-Total
		In Tennessee Add 8.25%
THANK YOU FOR YOUR ORDER!!			TOTAL