Book and Video Order Form

Please make checks payable & mail to:

Lois Griffel,
3363 S. Calle del Albano
Green Valley, Arizona USA
85622.

Name: __________________________________________________________

Address: ________________________________________________________

City: ________________________________ State: _________ Zip:________

Phone: day: __________________________ eve: ______________________

Email: __________________________________________________________

Video/Videos Vols: _________________ Total: _________

Grand Total: _______________________

Check enclosed payable to Lois Griffel for total due:    Yes_____

Please charge my: (check one)

Master Card ___   Visa ___   Account Number: ________________________

Exp. Date: ____________________________

Signature: _________________________________ Date: _____________

Do you prefer your confirmation package by snail mail or email?

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