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Order Form for Rutherford Family Video
********************************************************************** V I D E O T A P E O R D E R F O R M for "W H E N M E M O R I E S L I E... T H E R U T H E R F O R D F A M I L Y S P E A K S T O F A M I L I E S" Mail Order To: FMSF Video Rt. 1 Box 510 Burkeville, TX 75932 DATE: / / Ordered By: Ship to: Please type or print information: +--------+-----+------------------------------------+-------+--------+ | QUANT- | # | DESCRIPTION | UNIT | AMOUNT | | ITY | | | PRICE | | +--------+-----+------------------------------------+-------+--------+ | | 442 | The Rutherford Family | 10.00 | | | | | Speaks to Families | | | +--------+-----+------------------------------------+-------+--------+ SUBTOTAL | | | | +--------+ ADDITIONAL CONTRIBUTION | | | | +--------+ TOTAL DUE | | | | +--------+ U.S. Shipping & packaging charges are included in the price of the video. FOREIGN SHIPPING AND PACKAGING Canada $4.00 per tape All other countries $10.00 per tape. Allow two to three weeks for delivery. Made all checks payable to FMS Foundation. If you have any questions concerning this order, call Benton, 409-565-4480. The tax deductible portion of your contribution is the excess of goods and services provided. THANK YOU FOR YOUR INTEREST ********************************************************************** |