ATTENTION!
This orderform is for customers responding to the "Give a Gift to the World" Campaign. If you are looking to Purchase quantities over 100, please call Pneuma Life Publishing, Inc. 301-218-8928
Personal Information
Payment Information
First Name
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Card #
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Last Name
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Type
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Visa
Master Card
Address
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Exp. Date
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Month
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2004
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City
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Product Information
State/Zip
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Zip
Select Order
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1 DVDs = $10
2 DVDs = $20
3 DVDs = $30
4 DVDs = $40
5 DVDs = $50
6 DVDs = $60
7 DVDs = $70
8 DVDs = $80
9 DVDs = $90
10 DVDs = $100
Phone
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Quantity
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e-mail
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Shipping
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You will be charged $2 per DVD
For the order of DVD episode,
Cocomon and the Fruitytoons ™
On Completion of this form press submit. We will send you a confirmation number via email. Your account will not be charged until you have recieved a receipt from our office giving you the total your card will be charged. Please ad the order price and the shipping to confirm that the amount you have and the amount we charged your card is correct.
