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Name:
Email:
(please double check spelling)
Company (optional):
Address:
City:
State:
Country:
Zip:
Phone: () -
( ) I am enclosing a check or money order for $37.00 each (USD)
( ) I want to charge this purchase to my Credit Card
| Credit Card (check one): | VHS/DVD |
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VISA |
New Home VHS |
| MasterCard | New Home DVD |
| Discover | Existing Home VHS |
| Existing Home DVD |
Card Number:
Exp Date:
Signature: _________________________
I authorize Phillip Rye and Associates to charge $ USD to my
credit card for the purchase
of the Doug Rye Home Energy Saving VHS/DVD.