Video Language
P.O. Box 3726
South Pasadena CA 91031-6726
URL: www.videolanguage.com		 ORDER FORM
Please print		 TollFree: (800) 367-3806
FAX: (888) 252-6155
Email: orders@videolanguage.com

Date _________________20____
BILL TO: SHIP TO:
School/Institution___________________________ School/Institution___________________________
Name_________________________________________ Attention____________________________________
Address______________________________________ Street Address_______________________________
City State Zip_______________________________ City State Zip_______________________________
Country______________________________________ Country______________________________________
Telephone____________________________________ Telephone____________________________________
Email________________________________________ Orders shipped within 10 days days of receipt
Product Name Description/Format Price US$ Qty Total Cost
IN ENGLISH ON YOUR OWN
each unit includes 3 DVDs
 Volume 1Unit 1 69.00   
Unit 2 69.00    
Unit 3 69.00    
Unit 4 69.00    
IN ENGLISH
each volume includes 2 DVDs
 Volume 2 Units 5-6 60.00   
Volume 3 Units 7-8 60.00    
Volume 4 Units 9-10 60.00    
Volume 5 Units 11-12 60.00    
IN ENGLISH STUDENT WORKBOOK Volume 1 Units 1-4 6.95   
Volume 2 Units 5-6 6.95   
Volume 3 Units 7-8 6.95   
Volume 4 Units 9-10 6.95   
Volume 5 Units 11-12 6.95   
IN ENGLISH TEST PACKAGE Pre and Post Test 50.00   
ALPHA BOOK Teacher Edition 10.95   
Student Edition 6.25   
Site License to Duplicate, Master & CD-ROM129.95   
Total Cost of Merchandise  
California customers add local sales tax  
Shipping/handling 8% ($6.50 minimum)  
TOTAL  
PAYMENT METHOD:
CHECK ENCLOSED VISA MASTERCARD   **Individual orders must include payment
Card No._________________________________________Expiration Date_____________________

Signature___________________________________________________________________________
 
AUTHORIZED PURCHASE ORDER (Terms: Net 30)   Purchase Order No.__________________________
(Please write "F.O.B. Vendor" on your Purchase Order. Shipping charges will be prepaid by us and added to our invoice to you.

For quantity discounts, call for a bid.
Prices subject to change without notice Effective January 2013. All prices are in US dollars.
Minimum shipping charge: $6.50. Outside U.S. call/email for shipping charges.