Voice of the Victims

Mail Order Form

Please complete the following, print and mail to:

Voice of the Victims

Beth Pearce

22892 Mill Creek Drive

Laguna Hills, CA 92653

Please include your payment of a Money Order, Check, or Cashiers Check Be sure to add appropriate shipping and handling fee.

Please provide us with your contact information

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

URL

DESCRIPTION
QTY PRICE Sub-Total

Professional such as teachers, counselors, etc.

Please choose from the Multi Viewer Licenses for the "True Stories of Ecstasy and Ketamine"

Sub-Total
CA Residence Add Tax 7.75%
Please add appropriate shipping and handling charges.
Any single-dvd order: Free
Teen and parent two-dvd combination: Free
Total

Please complete the following if shipping to an address different than the one provided above.

SHIPPING

Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Is this a gift?

Yes No

Do you want to be anonymous?

Yes No

Would you like to receive periodic update about future product?

Yes No

Please enter today's date

-- mm/dd/yy

If you have any questions - please feel free to contact us at Orders@VoiceoftheVictims.com

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

DESCRIPTION	QTY	PRICE	Sub-Total



Professional such as teachers, counselors, etc. Please choose from the Multi Viewer Licenses for the "True Stories of Ecstasy and Ketamine"



		Sub-Total
CA Residence Add Tax 7.75%
Please add appropriate shipping and handling charges.
Any single-dvd order: Free
Teen and parent two-dvd combination: Free
Total

	SHIPPING
Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country