ORDER FORM

 

Name ___________________________________                    e-mail _____________________

 

Address _________________________________

 

City, State, Zip ___________________________

 

 

Quantity  Title Price Total
  Rebels with a Cause (DVD) $15 $
  Rebels with a Cause (VHS) $ 5 $
  Rebels with a Cause (book) $18 $
  Freedom is Contagious (DVD) $15 $
  Freedom is Contagious (VHS) $ 5 $
  Prairie Radical (book) $15 $
       
  Add $2.00 shipping for each item   $
       
 

TOTAL

  $

 

Send order and check to:     

Helen Garvy - Shire Films

326 San Juan Ave

Santa Cruz, CA  95062

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