MECHANICS N MOTION
DVD ORDER FORM

DATE ORDERED _______/______/ _______

NAME _______________________________________________________
PHYSICAL ADDRESS ____________________________________________________
CITY , STATE , ZIP _______________________________________________________
HOME PHONE __________________________________________________________
CELL PHONE ___________________________________________________________
EMAIL ADDRESS _______________________________________________________


QUANTITY TO ORDER __________

CREDIT CARD INFO:
Circle One:  MASTER CARD   VISA   AMEX
CREDIT CARD # _________________________________________
EXP. DATE _________________________________________
3 DIGIT SECURITY CODE  _________________________________

PLEASE CHARGE MY CARD $89.00 PER DVD SET ORDERED PLUS FED EX SHIPPING CHARGES.

SIGNATURE  _____________________________________________

DATE _________________________________________

OPTIONS TO SUBMIT ORDER:
1. PRINT & FAX FORM TO: 425-222-3541
2. TELEPHONE ORDER: 817-247-5883
3. MAIL TO:

Mark Shaffer
806 Gene Autry
Tioga,TX 76271