Pinball Order Form

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[HISTORY OF PINBALL]

Order Form

Please provide the following contact information:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Telephone

E-mail

Please provide the following ordering information:

BILLING

Credit card

Cardholder name

Card number

Expiration date

SHIPPING

Street address

Address 2

City

State/Province

Zip/Postal code

Country

History of Pinball -US (NTSC) $24.95 Number of tapes

History of Pinball -Europe (PAL/SECAM) $34.95 Number of tapes

U.S. Orders - Please add $4.95 for shipping and handling.
International Orders - Please add $7.95 for shipping and handling.
Please allow 4-5 weeks for delivery.

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