DVD WHOLE SALE ORDER FORM

Please insure you go back over the order form and verify your information is correct

Name

Street Address

City

State
AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code

Item#	Quantity	Description	Cost
	0 1 2 3 4 5

Item#	Quantity	Description	Cost
	0 1 2 3 4 5

Item#	Quantity	Description	Cost
	0 1 2 3 4 5

How would you prefer to pay for your selection?

Check
American Express
Visa Card
MasterCard
Discover Card
What is your shipping preference?

UPS
USPS
Federal Express
Will Pick Up

Ask (William Hambsh) for more information.