Video Order Form
---------PRINT AND MAIL FORM TO THE ADDRESS BELOW---------
**** SHIPPING
AND HANDLING ALWAYS !!
****
VHS T'ai Chi
Ch'uan:
$50 each X Quantity ______ =
Subtotal ___________
VHS Hsing Yi Ch'uan Part
1:
$30 each X Quantity ______ =
Subtotal ___________
VHS Hsing Yi Ch'uan Part
2:
$30 each X Quantity ______ =
Subtotal ___________
VHS Shien T'ien Pa Kua Tsang:
$50 each X Quantity ______ =
Subtotal ___________
DVD Hsing Yi Ch'uan Parts 1 & 2:
$40 each X Quantity ______ =
Subtotal ___________
DVD Shien T'ien Pa Kua Tsang:
$40 each X Quantity ______ =
Subtotal ___________
DVD
T'ai Chi
Ch'uan:
$40 each X Quantity ______ =
Subtotal ___________
Total/Check or Money Order Enclosed: US$ ____________
(Make Check or Money Order Payable to: Her Yue Wong)
Send all orders to:
Dr. Her Yue Wong
5203 Holly Street
Bellaire, Texas
77401-4803
Ship To:
Name: ___________________________________________________
Street Address or P.O. Box __________________________________
Apartment # _______
City __________________________________ State ______________
ZIP Code _____________