Order Form - Penn Valley Pictures

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)286-4618
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:

Mastercard

Visa

Please check preferred media:

VHS Tape

DVD


	We need expiration date and signature to ship your order


Expiration Date
	Month	Year
Card Holder's Signature_____________________________________

TOTAL
PA SALES TAX 6%
SHIPPING
TOTAL

Name	__________________________
Address	__________________________
City, State, Zip	__________________________
Phone	__________________________

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