Order: Bienvenidos a 4-H (video)

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Publication Order Form

Item#	Publication/Video/DVD Title	Price	Quantity	Subtotal
VTP 40	Bienvenidos a 4-H (video/DVD)	$19.95 20% discount 40% discount	(1-9) _____ (10-49 )_____ (50+) _____	$_______
Total Enclosed (payable in U.S. funds to Oregon State University)				$_______

First & Last Name
Billing Address City/State/Zip+4
Shipping address City/State/Zip+4
Phone
Payment method	Check Purchase Order # Credit Card (Visa or MasterCard; Miniumum order $5)
Credit Card Acct:	_______________________________________
Expiration Date	_______________________________________
Signature	_______________________________________

(For your security, please do not send credit card numbers via e-mail.)