The Cinema Guild, Inc. Order Form

Date:
Customer No.

Purchase Order No.
Shipping Information

Name:

Address:


City:

State:

Country:

Zip Code:

Phone:

Email:

Fax:


Billing Information (same as Shipping )

Name:

Address:


City:

State:

Country:

Zip Code:

Phone:

Email:


Fax:

Credit Card Orders
Card Type Card Number Expiration Date


Film and Video Orders
Title Format Quantity Per Unit Price Total
Shipping & Handling Charges For Purchases

For One Video - $8
For Two Videos - $11
For 3 Videos Or More,
Add $1 For Each Additional Video


Shipping & Handling Charges For Rentals

$13 per Video
$20 per 16mm Film
$25 per 35mm Film
Shipping & Handling Charges
Total Price