ORDER FORM
Print out, fill
in and check the necessary blank spaces below.
Name__________________________________________________________________________
Organization____________________________________________________________________
Address________________________________________________________________________
Phone/Fax______________________________________________________________________
Email__________________________________________________________________________
* Number of individual copies: ____
X $10 =
_____ (Your cost)
* Preferred format/s: VHS_____ DVD_____
How did you hear about the film?
Feel free to fax the
completed order form ahead of your payment. Please make your check
payable to At The ROOTS Films. Once your order is processed, please allow 3
to 10 days for shipping. Send payment to:
1376 W. Grand Ave.
Chicago, Illinois 60622
Phone: (773) 957-5455
attherootsfilms@yahoo.com
www.attherootsfilms.com
Thank you for your purchase.
