Name______________________________                  Send to: Serpentine Video
Address  ___________________________                   4930 Saint Elmo Avenue
City/State       ______________________                       Bethesda, MD  20814
Zip/Postal Code   ___________________                      U.S.A
Country___________________________                      Fax: (301) 656-1658
                                                                                                Toll-Free: (800) 835-7537
Email address_____________________                       Outside US: (301) 654-2224
Phone____________________________                        
Fax______________________________


Item#           Description             Quantity    Unit Price      Total
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Postage and handling for Orders in the US:                       Subtotal       _________
Music 			                                                                               S hipping      _________
$5.00 for first three items.                                                            Sales Tax     _________
$.50 for each additional item.                                                          Total         _________
Videos DVDs and Books                          
$5.00 for first item
$1.25 for each additional item
                                                      
Maryland residents must add 5% sales tax.

Postage and handling for orders outside the US:
Music 
$9.00 for the first three items.
$2.00 each additional item.
Videos
$9.00 for the first item.
$4.00 for each additional item.
THERE IS A SURCHARGE OF $7.75 ON ALL INTERNATIONAL ORDERS.

Allow four to six weeks for delivery.

Make checks (payable in US funds only) to Serpentine

Method of Payment:  Check:___  Credit Card:_____
_____________________________________________________________________

VISA:______________       MasterCard:______________

Card Number:_______________________

Exp. Date:_________________________

How did you learn of our site?____________________________________________

Thank you for your order!