Print This Order Form and Mail with payment to the address below.

SilverWings
Video Order Form
$14.95

Name: __________________________________________________________

Address: ________________________________________________________

City: _______________________State: ___________Zip: _________________

Quantity: _____ x $14.95     Sub total: $ ______________

Sales Tax: Iowa residents add 5% sales tax 
                    Polk County, IA residents add 6% sales tax 

Shipping: $0.01 (Limited time offer! Shipping for a penny!)

Total: $ ______________

Payment Method (circle one):         Check       Money Order VISA       MasterCard     

Name as it appears on credit card:___________________________________

Credit Card Number:

       
       
       
       

Expiration Date: ____________________


Signature: _______________________________________________________

Send completed form with payment (no cash) to:

Silverwings Productions
P.O. Box 21053
Des Moines, Iowa 50321-0053

 E-mail inquiries to sales@movingvideo.com
Videos shipped Priority Mail 24 hrs after payment is received. (checks must clear before shipping)