| Due
to credit card anti-fraud settings, only US residents can buy the video online at
this time. If you live outside the United States and would like to buy either: - video #1 (VHS NTSC or DVD format) or - video #2 the newest DVD please follow the instructions below. All sales are final, replacement only You
can fill in this form in your browser and then PRINT
it using the browser.
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| Bill To: | |
| First Name: |
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| Last Name: |
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| Company: | |
| Address: |
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| City: |
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| State/Province: |
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| Zip/Postal Code: |
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| Country: |
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| Phone Number: | |
| Fax Number: | |
| Email Address: |
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| Ship To: | |
| Leave Blank if Same as Billing Address | |
| First Name: | |
| Last Name: | |
| Company: | |
| Address: | |
| City: | |
| State/Province: |
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| Zip/Postal Code: | |
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| Phone Number: | |
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Credit Card. |
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| You can pay by any
of the methods above. Please choose one.
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| Payment Type | (Circle one) Visa MasterCard AmericanExpress |
| CC Number | Enter 0-9 (NUMBERS) ONLY! |
| Expiration Date: | |
| Actual Name on Credit Card | |
| Credit Card Billing Address | |
| Credit Card Billing Zip | |
| I
hereby authorize the above charges to my credit card by EliseOnline Sign here:_______________________________________ Date:__________________ |
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| Click File
> Print in your browser.
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Mail order form and payment to: EliseOnline PO 4271 Seminole, FL 33775 |