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Billing Address: Name Address City Zip Code Phone Number Fax Number Contact Name Shipping Address: Name Address City Zip Code Phone Number Fax Number Contact Name State State Date Order Form Class # Horse/Rider Description Quantity Unit Price Amount Special Instructions: Total State Tax @ Federal Tax @ Shipping Charge Grand Total Burn each class to a separate DVD (Additional Charges May Apply) Authorized By: ________________________________________ P. O. Box 690171 * San Antonio * TX * Phone: 210-771-5060 * Fax: 210-699-6699 * [email protected] www.VictoryPassVideos.com Credit Card # Exp. Date Code Keep on File Back # ASHA Member TASHA Member NTASHA Member Barn Name

Victory Pass Videos Order Form

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Order form to reserve camera space at the upcoming horse show.

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Page 1: Victory Pass Videos Order Form

Billing Address:

Name

Address

City

Zip Code

Phone Number

Fax Number

Contact Name

Shipping Address:

Name

Address

City

Zip Code

Phone Number

Fax Number

Contact Name

State State

Date

Order Form

Class # Horse/Rider Description Quantity Unit Price Amount

Special Instructions: Total

State Tax @

Federal Tax @

Shipping Charge

Grand Total

Burn each class to a separate DVD (Additional Charges May Apply)

Authorized By: ________________________________________

P. O. Box 690171 * San Antonio * TX * Phone: 210-771-5060 * Fax: 210-699-6699 * [email protected]

www.VictoryPassVideos.com

Credit Card # Exp. Date Code

Keep on File

Back #

ASHA Member TASHA Member NTASHA MemberBarn Name