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
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