Bonding Through Touch Video Order Form
	Videos or DVDs will be shipped upon receipt of check or money order. Please print out order form and send with payment to: Joni Rubinstein DBA Three Hearts 2545 W. Rapallo Way, Tucson, AZ 85741

Description: Please check either DVD and/or Video DVD _______        VHS Video _______		SHIP TO: NAME_______________________________________ ADDRESS____________________________________ CITY________________________________________ STATE_____________________ZIP______________ COUNTRY_________________TEL.______________ PROGRAM NAME ____________________________ ATTENTION:_________________________________
Quantity: DVDs _____ x @ $20.00 ea. = VHS _____ x @ $20.00 ea. =	_____.__ _____.__
Add $6.00 Shipping and Handling PER DVD or Video	_____.__
Sales tax (if in Arizona) For orders shipped within AZ add $5.6% sales tax ($1.12 each)	_____.__
TOTAL Enclosed	_____.__

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