BRC Productons, P.O. Box 158, Dearborn Heights, MI. 48127-0158; FAX (313) 277-3095 brcradio@brcradio.com
Simply print this form out and fax or mail, or copy and paste it into an e-mail.

BRC AUDIO VIDEO ORDER FORM

Date_______________________________

Name_______________________________Address____________________________________

City_____________________________State________________Zip_______________________

E-mail address_______________________ Daytime phone____________________________

SPECIFY VHS VIDEO, CD OR AUDIO CASSETTE WHEN APPLICABLE

 Quantity Title / Description Catalog Number  Price Each Total Price

 1

      

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    Sub-total:  
    Michigan only 6% sales tax:  
    Shipping:  
    Grand Total:  
Shipping/handling charges are as follows: 1 - 9 or more videos or any size audio order $5.00 within the Continental USA, or $8.00 elsewhere. Shipping is FREE when 10 or more videos are ordered at one time.

Send us a note if you need more details on how to order...E-MAIL: info@brcradio.com FAX: (313) 277-3095 | MAILING ADDRESS: BRC Productions, P.O. Box 158, Dearborn Heights, MI 48127-0158.

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