Beijing Video
P.O. Box 72003
Las Vegas, NV. 89170
- Payable to: Ralph Allen

      (Please Print)

Tape-1:__________________________________    Tape-11:______________________________________

Tape-2:__________________________________    Tape-12:______________________________________

Tape-3:__________________________________    Tape-13:______________________________________

Tape-4:__________________________________    Tape-14:______________________________________

Tape-5:__________________________________    Tape-15:______________________________________

Tape-6:__________________________________    Tape-16:______________________________________

Tape-7:__________________________________    Tape-17:______________________________________

Tape-8:__________________________________    Tape-18:______________________________________

Tape-9:__________________________________    Tape-19:______________________________________

Tape-10:__________________________________    Tape-20:______________________________________


 If you run out of space, write Alternate titles on the back of this form.
(Not listing alternate titles can delay orders where certain movies are not available).

Name:_____________________________________

Street:_________________________________________  

City:_________________________________State:_______ZIP:_____________

Phone/E-mail:_______________________________________________________

All prices do Not include shipping.
Shipping is $5.00 for the first movie ordered and $1 for each additional tape ordered. All orders of (10) movies or more shipping is a flat $18.00 (unless specified).

Please read Overseas Orders and the Sale of the Month for shipping prices.

My placement of this order indicates that I have read and agree to the terms.

Signature:_____________________________________________   Date:________________
Check or Money Order Number:________________________________________

Thank you for your order!

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