I would like to order ___ DVD's x $12.95 =

Subtotal =

Kentucky residents add sales tax (6% of subtotal)  =

Shipping =

TOTAL DUE:

Make check payable to "Gerlach Productions" and send it along with this form to:  

Gerlach Productions

344 Fox Harbour Drive

Lexington, KY  40517

Please ship to:

Name: _____________________________________                

Street/PO Box: _____________________________________                

City-State-Zip: _____________________________________               
                

E-mail: _________________________   Phone number: _________________