COMPLETE & PRINT
FAX or MAIL this
form to place your order.
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How did you hear about us?
I have enclosed a check. Payable to: Russ InVision
Check
one:
Visa
Master Card
Enter Credit Card Number:
Expiration Date: Month
Year
Security Code
(Last 3 digits on the back of the card)
X_____________________________________
Authorized Signature on above credit card
Purchase Order Attached P.O. Number:
School
Districts, Non-Profits,
Fax signed P.O. to 562-420-9101
Corporations, etc.
Billing
Information (Required for credit card purchases)
(Address & phone must match where your credit card bill is sent)
Name of Card Holder
E-mail
Telephone
Fax
Company
Address
Address2
City
State
Zip
If shipping is the same as billing, check here. If not, complete shipping section below.
Shipping Information (If different from Billing)
Name of Recipient
Telephone
Company
Address
Address2
City
State
Zip
How would you like your order confirmed?
(check
one)
Fax
E-mail
E-mail
Print this completed form
FAX to (562) 420-9101
MAIL to Russ InVision: 5740
Oxholm St., Long Beach, CA 90808
Note: You cannot e-mail this form. This is not a
secure server.
children's music
preschool music