Fax Order Form To: (503) 213 - 9074

PIN! & Ink
PO Box 923 Moravian Falls NC 28654

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Address

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Credit Card ( ) VISA ( ) MasterCard

Card No & Exp Date


Date and Signature


Email Address


DOMESTIC SHIPPING CHARGES

[ 1 DVD: $3 for 1st Class Mail ] • [ 1 to 3 DVD US Priority Mail: $5.00 ] • [ 1 to 2 VHS Tape: $5.00 US Priority Mail ]

[ 4 or more DVDs, or 3 or more VHS tapes: $8 for US Priority Mail ]

List Items Ordered Below