Michelle Eccles Horse Training

Keepin’ It Fun

Video Order Form

2009 Hancock Highway

Honesdale, PA 18431

570-470-5610

Your name ______________________

Mailing Address __________________

________________________________

Shipping Address_________________

________________________________

Daytime Phone___________________

Evening Phone___________________

Please Specify: DVD or VHS

Price Per Video: $24.00

Quantity: _____ X $24.00 = ______

PA residents add 6% sales Tax: ______

*Shipping/Handling: $3.50 per video: _______

Grand Total: _________

Method of Payment: Check/Money Order/Visa/MasterCard/Discover

Check number:_____

Credit Card Number:___________________EXP. Date:____

CVV Number on back of card: (Lat 3 digits) _______

Name on Card:_________________Signature: ________________

THANK YOU FOR YOUR ORDER! :)

IT WILL BE SHIPPED IMMEDIATELY

*For special shipping please call Michelle