Make your own free website on Tripod.com

Film Order Form
Please accept my order for the following films on the Ancient Chamori Royal Wedding. Enclosed, please find my check or money order, made out to Guahan Industries in the amount of  $_____________.

Name:
Address:
City: State: Zip:
Daytime Phone: Nighttime Phone:
Bill My:   WB01388_.gif (106 bytes) VISA   WB01388_.gif (106 bytes) MasterCard   WB01388_.gif (106 bytes) American Express   WB01388_.gif (106 bytes) JCB
Card #: Expiration Date:
Signature:
Quantity Item No. Description Unit Price $ Total Order $
  V-01 Royal Wedding (Original) $15.95 $
  V-02 Royal Wedding (Documentary) $15.95 $
  V-03 Royal Wedding (Japanese) $15.95 $
  V-04 Royal Wedding (Chinese) $15.95 $
  V-05 Royal Wedding (Korean) $15.95 $

Shipping & Handling Charge..Add $2.00 Per Film.

$

Sales Tax (if applicable)

$

Total Order

$

AG00113_.gif (2541 bytes) Please send Check or Money Order to...


Pugua' International Corporation
1050 Bishop Street, Suite 200
Honolulu, Hawaii 96813
Tel: (808)247-8742

To Print this document, click on "print..." under the "File" menu.