A&A
Media Mail Order Form
YOUR SHIPPING INFORMATION
NAME
______________________________________________
ADDRESS
______________________________________________
CITY
______________________________________________
STATE
______________ ZIP CODE __________________
CONTACT EMAIL (Shipping Notification) or PHONE
NUMBER (OPTIONAL)
______________________________________________
SHOW TITLES
PRICE
______________________________________________ $ ______________
______________________________________________ $ ______________
______________________________________________ $ ______________
______________________________________________ $ ______________
SHIPPING $
______________
TOTAL $ ______________
Shipping Prices for USA Only
0
- $9.99 = $1.49
$10 - $19.99 = $3.99
$20 - $28.99 = $4.99
$29.99 - $199.99 = $5.99
$200 and Up = $9.99
PLEASE SEND CHECK OR MONEY ORDER
PAYABLE TO 'A&A MEDIA' TO:
A&A Media
10751
Sheridan Dawn Court
Henderson, NV 89052
U.S.A.