A&A
Media Mail Order Form
YOUR SHIPPING INFORMATION
NAME
______________________________________________
ADDRESS
______________________________________________
CITY
______________________________________________
STATE
______________ ZIP CODE __________________
CONTACT EMAIL (Shipping Notification) or PHONE
NUMBER (OPTIONAL)
______________________________________________
SHOW TITLES
PRICE
______________________________________________ $ ______________
______________________________________________ $ ______________
______________________________________________ $ ______________
______________________________________________ $ ______________
SHIPPING $
______________
TOTAL $ ______________
Shipping Prices for USA Only
0 - $9.99 = 99
Cents
$10 - $49.99 = $5.99
$50
- $199.99 = $6.99
$200
and Up =
$8.99
PLEASE SEND CHECK OR MONEY ORDER
PAYABLE TO 'A&A MEDIA' TO:
A&A Media
10751
Sheridan Dawn Court
Henderson, NV 89052
U.S.A.