Charlestown Powder Plant Video Order Form

Charlestown Powder Plant
Video Order Form

VHS Video Tape $20.00
DVD Video $20.00

Quantity	VHS or DVD	Price (ea.)	Total (ea.)
_______	______________________________	_______________	_______________
_______	______________________________	_______________	_______________
		Shipping & Handling*	_______________
		TOTAL	_______________

*Shipping is $4.00 for the first video/DVD and $1.00 for each additional video/DVD.

Billing Address

Shipping Address
(If different than billing address)

Name:___________________________________

Street:___________________________________

City:__________________________

State:______ Zip:_______________

Telephone:_______________________________

Name:___________________________________

Street:___________________________________

City:__________________________

State:______ Zip:_______________

Telephone:_______________________________

Credit Card: _____Mastercard _____Visa _____American Express _____Discover

Exact Name On Card: _________________________________

Credit Card Number: __________________________________ Expiration Date: _________________

Make checks payable to Natural Concepts

Orders can be mailed to the following address:
Natural Concepts
3604 Sea Pine
Jeffersonville, IN 47130

(812) 284-4207
(812) 285-0785 fax

Billing Address

Shipping Address (If different than billing address)

Shipping Address
(If different than billing address)