VIDEO ORDER FORM FOR SPEED SECRETS  TV SHOWS

Please Print out this Form and Completely Fill Out.

Name__________________________________________________       Mail your order form and check to: 

Street or PO Box_________________________________________      Speed Secrets Video

City______________________ State__________ Zip____________      Wayne Dake

Day Phone(___)_____________________________                              2863 Yankee Hill Road

Night Phone(___)____________________________                              Milford, NE 68405

E-Mail Address______________________________

1. Below, indicate the number of copies preceding the appropriate  video format you wish to order. 

          ____VHS            x $19.95 = $___________    

          ____Mini DV       x $29.95 = $___________

          ____DVD            x $29.95 = $___________

          Add 7.0% Nebraska Sales tax $___________

          Add $2.50 (s&h) per video    $___________

          TOTAL>>>>>>>>>>>>>>>  $___________

2. Indicate which Week number and the guest(s) on the show.

        Week #_____          Guest Name(s)____________________________________

        Week #_____          Guest Name(s)____________________________________

        Week #_____          Guest Name(s)____________________________________

        Week #_____          Guest Name(s)____________________________________