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VHS/DVD Order Form |
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Name:
_____________________________________________________________________ |
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Street:
_____________________________________________________________________ |
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City:
_______________________________________________________________________ |
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State:__________________
Zip: _________________________________ |
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Phone:
_____________________________________________________________________ |
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E-Mail:
____________________________________________________________________ |
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Current Member of the USRT:
.............................. Yes No |
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Donated VHS/DVD
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VHS:_________________________________ +Shipping |
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DVD:_________________________________ +Shipping |
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Library Order
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VHS: Name & Item #____________________________ |
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________________________________________+Shipping |
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DVD: Name & Item #____________________________ |
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________________________________________+Shipping |
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I accept the Terms and Conditions of this order by |
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ordering the above VHS or DVD on a loan basis. |
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Signature: _____________________________ |
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Date: _________________________________ |
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Mail Order to: Kim Smith at
1015 E 49th N, Idaho Falls, ID 83401
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Note: For USRT use only:
Date Order Received: _________________________
Date Order Shipped: __________________________
Date Order Received: _________________________
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