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Customer Information |
Date of
Order: ____________________________
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Name:
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_________________________________________________________
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Shipping Address:
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_________________________________________________________
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City/ State/ Zip/Country:
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_________________________________________________________
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| Phone |
___________________________ |
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Fax
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___________________________
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E-Mail:
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_________________________________________________________
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Billing Address:
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(Only if different from the above
information)
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Name:
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_________________________________________________________
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City/ State/ Zip/Country:
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_________________________________________________________
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Country:
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_________________________________________________________
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| Credit Card Information |
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Credit Card:
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[ ] MasterCard [ ] VISA [ ] AMEX
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| Name On Card: |
_________________________________ |
| Expiration Date: |
______________ |
| Credit Card Number: |
_______________________________________________________ |
| Security Code |
_____________
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| Signature: ________________________________________
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Please make checks & money orders payable to: The Art Explorers Inc.
Mail Orders to: GOS TV Series DVD, c/o The Art Explorers, Inc. 500 N. Michigan Ave. Suite 300, Chicago, Illinois 60611
FAX to: (773) 743 - 3541 Phone: (312) 932-9305
Email: sales@theartexplorers.com
Note: "Security Code" is the last 3 or 4 numbers on back of card or 4 on AMEX front.
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