ORDERFORM

ORDER FORM

Please type or print clearly. Use our Item Numbers when ordering and fill out the form completely, including your telephone and fax numbers. Attach a copy of your purchase order if applicable (U.S. and Canada only). Incomplete forms may delay shipping.

BILL TO:	SHIP TO:
Name___________________________________________	Name_______________________________________________
Company Name________________________________	Company Name___________________________________
Company Division/Department______________________	Company Division/Department________________________
Address_________________________________________	Address_____________________________________________
City__________________________________________	City__________________________________________
State/Province____________________________________	State/Province_______________________________________
Zip/Postal Code, Country __________________________	Zip/Postal Code,Country_______________________________
Telephone___________________FAX________________	Telephone_____________________FAX__________________
Email:___________________	Email:_____________________


Quantity	Item Number	Tape Format PAL or NTSC	Title	Language	Price (US Dollars)
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
_______	_______	__________	__________________________________________	_______	_______
				Subtotal	_______
(Shipping for foreign orders may be higher)Shipping & Handling (Add 9% of				Subtotal):	_______
			TOTAL	INVOICE	_______

Check or money order enclosed_____
Attach Purchase Order (U.S. and Canada orders only)_________________________________________
VISA/MasterCard/AMEX (circle one) #______________________________ Exp. Date ____________________
Signature: _______________________________________________________Date____________________

Quantity discounts are available, for more than two (2) copies of the same tapes. Please contact One Source 4 Media.
Academic discounts are available only to organizations that grant degrees, and with the understanding that
the videotapes are to be used exclusively in an academic environment. Please contact One Source 4 Media.
All orders from outside the United States must be prepaid in U.S. currency.
All prices and availability are subject to change without notice.
If you are dissatisfied with an item for any reason, you may return it within 15 days and One Source 4 Media will refund the price paid minus shipping and handling charges.

3810 Old Rosebud Court, Suite H Clemmons, NC 27012

Toll Free Telephone: 1-800-236-3637
Local Telephone 1-336-201-6803

Fax : 1-336-766-3656