Video Order Form

UCSB-TV Video Order Form

Print This Page ~ Fill Out ~ Mail In

All UCSB-TV programs have been professionally produced for UCTV. Both DVD & VHS tapes cost $19.95 each. Tax— for California residents only—is $1.75 on $19.95. To obtain correct tax, multiply Subtotal by .0875 (i.e.,8.75%). Shipping 1 VHS or 2 DVDs = $4.50.

Title	Catalog No.	Qty	Cost	Total

[With Quantity, please indicate either DVD or VHS--which do you prefer?]	Subtotal	___________
	Calif. Tax	___________
	Shipping	___________
	Total Cost:	$__________

Ship to: Name: __________________________________________________________

Address Line 1: ___________________________________________________

Address Line 2: ___________________________________________________

City, State, Zip: ___________________________________________________

Phone Number: ( ) _____________ — _________________________

E-mail: __________________________________________________________

~ Please pay by credit card or by check payable to "UC Regents" ~

CREDIT CARD INFO [VISA & Master Card ONLY]:	MAIL ORDER AND PAYMENT TO:

Credit Card Type: ___________________ (VISA/MC Only) Account Number: __________________________________ 3-digit ID #_________________* Expiration Date: __________________________ Signature: _______________________________	Instructional Resources UCTV University of California Santa Barbara, CA 93106-3200 Tel: (805) 893-8812 Fax: (805) 893-8719 E-mail: uctv@id.ucsb.edu

*On all orders to be charged to a credit card, give also the 3-digit ID# from the back of the card. This number is printed in the white signature panel on the back of your card. It follows the credit card number on a VISA card. Only the last 4 digits of the credit card are printed on a Mastercard, but they are followed by the ID#. Thank you.