University of King`s College Encaenia 2013 DVD Order Form

Customer E-Mail

E-Mail:*

Category

Product Selection

Qty

Total

DVD

Sub-Total:

Grand Total (tax included)

Billing Information

First Name:*

Same name as on your card

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Apt. or Suite No.

City:*

Province or State*

Postal Code or Zip Code*

Phone:

Shipping Information

Same as billing info:

Yes No

First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

City:*

Province or State*

Postal Code or Zip Code*

Payment Information

Card Type:*

Visa and Mastercard only

Card Number:*

No dashes or spaces please

Expiration Month:*

Expiration Year:*

CVS Code*

3 Digit Code on back of card

Name*

Exactly as it appears on card

Enter the security code shown above
in UPPER CASE.

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