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 MasterCardName as it appears on credit card:___________________________________
Credit Card Number:
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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)