( Please print this form, fill out accordingly and include with your order.
)
Title of video
30 days
60 days
Total
.
$10.00
$15.00
.
.
$10.00
$15.00
.
.
$10.00
$15.00
.
.
$10.00
$15.00
.
.
$10.00
$15.00
.
.
$10.00
$15.00
.
Shipping: 1st disc $3.00 + $1.00 for each
additional disc
.
Grand total
.
" Shipping & Handling " Add $3.00 for the first disc
ordered. Add an additional $1.00 for each additional disc
ordered. All discs shipped via USPS Media Delivery Confirmation.
" ONLY PAYMENTS IN U.S. FUNDS WILL BE
ACCEPTED " SORRY NO
C.O.D.s ( This is due to the overwhelming
number of unfulfilled receipts of C.O.D. orders. ) We do not accept personal checks or credit
cards.
Make your cashiers check or money order payable to: . . K . E . N
.
Please mail your order to: . . . K . E . N
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . P. O. Box 465 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Watertown, South Dakota . .
57201 - 0465
Purchaser PRINT full name :
_____________________________________________