New Skete Monks Video Postal Mail Order Form
To use this form to order, print it with your printer, complete
it and mail it to Dr. Jeff at the addresss shown at the bottom.
Each order gives you a free consultation with Dr. Jeff.
Before completing and submitting the order form below,
enter this information:

PET'S NAME:
SPECIES:
BREED:
SEX:
NEUTERED? (Y OR N):
AGE:
PROBLEMS:

I wish to order:

(enter number:) ____ sets of the New Skete Monks' videotapes
at $64.95 per set of three tapes.

TOTAL AMOUNT OF PURCHASE:              [___.___]

The appropriate sales tax and a $5.00 per order shipping charge will
be added to the purchase amount.

SHIP TO:
Name:
Street:
Box or Apt. No.:
City or Town:
State or Province:
Country:
Zip or Postal Code:

Credit-Card Information

Type of card:
VISA: __     MASTERCARD: __   DISCOVER: __
Your Name:
Credit Card No.:
Expiration Date:

Your charge will be posted to your credit-card statement as a charge to
Dr. Jeff's Broad River Animal Hospital.