ORDERED BY:

Name ______________________________ Company Name ___________________________   

Address ____________________________________________________________________      

____________________________________________________________________________     

City ___________________ State _____ Zip ___________ Country _______________

Phone __________________ FAX ______________________ Email __________________

Price: $19.95 Per Video
Item Nbr. _____Qty. _______
Item Nbr. _____Qty. _______
Item Nbr. _____Qty. _______
Item Nbr. _____Qty. _______ 
Item Nbr. _____Qty. _______
Item Nbr. _____Qty. _______ 

SHIP MY VIDEO TO:   Confirm this order (circle one)   YES       NO

Name ______________________________ 

Address ____________________________________________________________________      

____________________________________________________________________________     

City ___________________ State _____ Zip ___________ Country _______________

Phone __________________ Special Instructions ______________________________

SHIPPING

 Send this order form along with your Cash, Check, or Money Order to:

                                            A.M.R. Productions c/o
                                            M.Roselli
                                                       409 Predmore Av.
                                            Lanoka Harbor, NJ  08734

 The charge for shipping will be $3.00  per Video.


Thank you for your order, And Enjoy The Show.