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ORDER FORM

CURTIS'S CHARM logo

An Alliance International Video Release
NOT FOR SALE IN CANADA

PHONE:

Visa, MasterCard, Discover, AmEx

Order your own copy of Curtis's Charm for $xx.xx (plus S/H). You can phone your order toll-free, print a form to mail your order, or submit this Secure Order Form:

Take 5% off your order when you submit this Order Form. (US only) 



Your Name:       

Email Address:    
Phone:		   

Street Address:   

City:              State/Prov:

Zip/Postal Code:  Country: 

Method of Payment:   
Name on Credit Card:  
Credit Card Number:  
Expiration Date:       




How many copies of Curtis's Charm do you want?

Leave the following fields blank if you want us to total your order for you: 

                                   Subtotal: $ 

 Less 5% for submitting this form (US only): $ 

                                   Shipping: $ 

         [STATE] residents add 6% Sales Tax: $ 

                                      Total: $

Shipping: (US) $5 for orders less than $75, $3 for orders of $75 or more. Orders sent outside the USA will require an additional shipping charge.

Special Instructions or Comments (optional):

If you prefer, you can print this form and mail it with payment by credit card, check, or money order to: XXXXX Checks take approximately 10 days to clear. To avoid this delay, use your credit card or send a money order.

Our telephone numbers are XXXXX and XXXXX.

For additional information on our products:

For more information about Curtis's Charm,
visit the Official Curtis's Charm Website.

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