IMPORTANT NOTICE

For credit card and check orders, this form may be mailed to us at the address on the form.

Fax orders will be accepted for credit card orders only.

Please do not attempt to send us credit card information via the internet.  We have no security for credit card transactions at this time.

If you have trouble printing this form, set left and right margins to “0” in your page set-up.  Also, reducing font size in you browser corrects some problems.

Penn Valley Pictures
P.O. Box 429, Sunbury, PA 17801 (570)286-4628
SHIPPING INSTRUCTIONS: 1 ITEM $ 5.00 EACH - EACH ADDITIONAL ITEM $1.00 EACH
PENNSYLVANIA RESIDENTS 6% SALES TAX

24 HOUR PHONE ORDER SERVICE
1-800-577-6003
FAX 1-800-577-6004

QTY

VIDEO TAPE / DVD

PRICE (Per Video)

TOTAL
         
         
         
         

CHARGE ORDERS: Please check card used:
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Mastercard
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Visa
   Please check preferred media:
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VHS Tape
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DVD
                               

We need expiration date and signature to ship your order

Expiration Date

Card Holders
Signature
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Month
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Year
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TOTAL

    

PA SALES TAX 6%

    

SHIPPING

    

TOTAL

    

Name
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Address
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City, State,
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Phone

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