Mail Order Form

Obstruction of Justice Order Form

Make Checks Payable to:

ID Media
9425 Carling
Little Rock, AR. 72209

Name: _____________________________________________________________

Address: __________________________________________________________

City: _____________________________________________________________

State: _________________ ZIP:_______________________

Phone: _____________________________
^{required if shipped 2nd day air}
Email: ____________________________________

Quantity: _______($14.95 each)

Sub Total: _________

Shipping Options

1 video- Regular Mail $3.95 each:

1-2 videos 2nd day service $7.95:

2-4 videos 2nd day service $8.95:

5-6 videos 2nd day service $9.95:

Total Amount: _______________

Credit Card Information

Visa:

Master Card:

Name: __________________________________________________________
^{exactly as it appears on credit card}

Credit Card Number: _____________________________________________

Expiration Date: _______________________

ID Media, 9425 Carling, Little Rock, AR. 72209
1-800-558-4308 * 501-568-2810