Video McLuhan / U.S.A. and International Mail Order Form

`Video McLuhan United States and International Mail Order Form`

Instructions: Print this tear-off ordering form to order by mail or fax.

PRICES

The Video McLuhan Set ------------------------------- U.S. $ 250.00
Shipping and Handling ---------------------------------- U.S. $ 15.00

TOTAL DUE: --------------------------------------------- U.S. $ 265.00

Please provide us with contact information in case we need to contact you about your order.

Contact name: _________________ E-Mail Address: _________________________
Phone (with area code)________________Fax (with area code)________________

Ship To:

Name:__________________________________
Organization Name: __________________________________
Street Address: ______________________________________________________
City: _________________ State: __________________ Country: ______________
Zip/Postal Code: _____________
Special Shipping Instructions:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Alojamiento de lujo Bojnice Send Invoice To:

Name to Appear on Invoice: __________________________________
Department: __________________________________
Organization Name: __________________________________
Street Address __________________________________
Glasgow hotelsCity: _________________ State: _______________ Country: _____________
Zip/Postal Code: _____________

Bath cheap hotelsMethod of Payment: (check one)

___ Cheque or money order enclosed (make cheques payable to Video McLuhan)
___ Institutional Purchase Order Number: # _____________________

Orders should be sent to:

Video McLuhan Inc.
73 Sighthill Avenue
Toronto Ontario M4T 2H1
Canada
Institutions may fax this order form with purchase order numbers to (416) 484-6825

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