RMAX.tv Productions Order Form

Name:

Date:

Shipping Address:

City:

State:

Zip Code:

Daytime Phone:

Evening Phone:

Email Address:

 

Item Description

Quantity

Price

  

Total

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

Subtotal

  

Shipping

  

($6.95 + $1.00/add. item domestic)
($12.95 + $2.00/add. item Canada & Mexico)
($16.95 + $2.00/add. item overseas)

Excluding Clubbells and Clubbell Bundles

  

Total

  


Credit Card Information

Name:

Date:

Billing Address:

City:

State:

Zip Code:


Type (Circle one):           Visa          MasterCard          American Express          Discover
Credit Card #:                                                            
Expiration Date:                                                            
Cardholder Signature:                                                            
Mail credit card orders to: RMAX.tv Productions PO BOX 501388 Atlanta, GA 31150 USA
Fax credit card orders to: 1-678-867-7676