The Past Is A Blast Offline Order Form

MAIL ORDER FORM

Print this order form then simply mail it to...

DeFiore Enterprises
5640 North Marty Avenue, #182
Fresno, CA 93711

Make checks payable to: DeFiore Enterprises.

I am ordering the following DVDs:

Quantity DVD Title

_______ _________________________________________________

Name: __________________________________________________________

Address: ________________________________________________________

City: _______________________ State: __________ Zip: _____________

Telephone: _______________________________________________________

Email Address: ___________________________________________________

How did you hear about us?__________________________________________

[ ] I have enclosed a check or money order for $_____________________