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Huntington Beach, CA 92648
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PAK-RAK III VIDEO REQUEST FORM

Order your PAK-RAK(tm) Video today! The $6.00 Charge is fully refundable with purchase of a PAK-RAK(tm).
Your First and Last Name:
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City: State: E-mail Address:
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When do you anticipate purchasing a PAK-RAK(tm)? Do you have any other comments?


Please Charge me $6.00 to cover the cost of my PAK-RAK(tm) video and postage.

Payment By: Visa Mastercard Please Call Me for an Order
Credit Card Number: Expiration Date:
Name that appears on the card:

Allow 2-3 weeks for shipment of your PAK-RAK(tm) Video! Price of the video will be refunded with purchase of your PAK-RAK(tm).




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Copyright © 1997 Deltronix Enterprises, This page was created by
Deltronix Enterprises, Most recent revision: Saturday, April 12, 1997