Banned Films Mail Order Form

BANNED FILMS REGULAR MAIL ORDER FORM
To order by mail, you may print this page or copy the pertinent
information and mail with your check made out to Network-Mall.
Please include your name and shipping address!

Name:

Address:

City, State, Zip:

MAIL TO:
Network-Mall
PMB 295
1412-B East Blvd.
Charlotte, NC 28203

Uncle Remus Ad w/ gift VHS Code: remus Price: $14.99	Quantity		Total
DVD Code: dvdsos Price: $17.99	Quantity		Total
Al Sharpton sticker w/gift Code: as Price: $29.00	Quantity		Total
Jewish Confederate Diary Code: jd Price: $11.00	Quantity		Total
The Black Crows Code: bc Price: $24.99	Quantity		Total
Silent Sam Poster only in canister Code: canposter Price: $20.00	Quantity		Total
Petigrew Biography Code: pettigrew Price: $25.00	Quantity		Total
4 Stickers 2 of each Price: $7.99	Quantity		Total
10 Stickers 5 of each Price: $14.99	Quantity		Total
30 Stickers 15 of each Price: $34.99	Quantity		Total
Hussein Stickers 10 stickers Price: $11.99	Quantity		Total
	SUB TOTAL:		$
Shipping Flat Rate		$ 6.00
NC Residents Only include 8% sales tax		$
GRAND TOTAL:		$