OFFLINE ORDER FORM
This form may be printed in order to mail or fax it.

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

If you are experiencing problems with this form, please contact us

email
las líneas
media

 

 

ITEM # ITEM NAME QUANTITY COST
CTLUDDVD of Crossing the Line For College/University at $1390.00
CTLUVVHS Videotape of Crossing the Line For College/University at $1390.00
CTLNDDVD of Crossing the Line For Labor Org, NGO, Public Library or High School at $740.00
CTLNVVHS Videotape of Crossing the Line For Labor Org, NGO, Public Library or High School at $740.00
  DHL Ground Shipping (2-3 weeks) See table of costs  
  0.00
  10% discount on 2 or more copies 0.00
  Total 0.00

PAYMENT OPTION
Your payment information will not be transmitted

Authorized Purchase Order
Institution
Purchase Order #

Payment by Check

Use only for orders via regular mail (no FAX).
Please enclose a check payable to Example.com.

Name (First/MI/Last)
Check number
Credit Card
Card Type
Card Holder Name (First/MI/Last)
Card Number (no spaces)
Card Verification
Number

MC & Visa: 3 digits after number on back of card
Am. Express: 4 digits on front of card above and to right of account number
Expiration Date Month (MM) Year (YY)
 

SHIPPING ADDRESS

Ship to Name
Email Address
Institution
Department
Address
(no PO boxes please)
City
State
Zip/Postal Code
Country USA (for Canada or Mexico email us)
Telephone
BILLING ADDRESS Check if same as shipping address
Bill to Name
Email Address
Institution
Department
Address
City
State
Zip/Postal Code
Country USA (for Canada or Mexico email us)
Telephone

PLEASE CHECK TO SEE THAT ALL FIELDS HAVE BEEN FILLED IN
before you finalize your order.

Missing information will cause delays
while we contact you.

Use your browser menu to print this form and mail
or FAX it to us.

FAX your order to: 845-774-2945

Mail your order to:
Las Lineas Media Library
Transit Media
P.O. Box 1084
Harriman, NY 10926

For questions call: 800-343-5540
or email info@transitmedia.net

 
contact us
see info about this shopping cart