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VHS/DVD Order Form | |||
Name: _____________________________________________________________________ | ||||
Street: _____________________________________________________________________ | ||||
City: _______________________________________________________________________ | ||||
State:__________________ Zip: _________________________________ | ||||
Phone: _____________________________________________________________________ | ||||
E-Mail: ____________________________________________________________________ | ||||
Current Member of the USRT: .............................. Yes No | ||||
Donated VHS/DVD |
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Library Order |
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________________________________________+Shipping | ||||
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________________________________________+Shipping | ||||
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ordering the above VHS or DVD on a loan basis. | ||||
Signature: _____________________________ |
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Date: _________________________________ | ||||
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: _________________________ |