PurchaseHISLAM

Order Form

PURCHASE FORM FOR
"Hawaii Slam: Poetry in Paradise"

TITLE	DESCRIPTION	PRICE (educational institutions & social organizations)	PRICE (individual home video use)	QTY	TOTAL
Hawaii Slam: Poetry in Paradise	VHS Video Cassette (NTSC) or DVD, 60minutes, USA, Color PLEASE CIRCLE ONE: DVD OR VHS	$125.95 (includes the license to use this video as a teaching implement in class and to hold small free screenings)	$19.95
Sender's name & mailing address: __________________________ __________________________ __________________________ __________________________ Telephone _________________ Email______________________ How did you hear about us? ____________	Shipping within the USA (Call for international rates) add: 1 item $5.00 2-3 items $7.50 4 items $9.00 5+ items $10.00
TAX (Hawaii Residents Add 4.166%):
TOTAL:
When ordering please clearly specify quantity of each item you wish to purchase. Include a mailing address and telephone number (e-mail optional). Make cheque, money order, or purchase order payable to: Kathryn Xian 4224 Waialae Ave. #248 Honolulu, Hawaii 96816 USA Tel: 808-599-3931 Fax: 808-521-2923

HAWAII SLAM: POETRY IN PARADISE