GOTO Becky's ONLINE Payment Form Contact Becky by email or 586.871.8351 OR You can use the Mail-in Form Below
2009 Grand Prix of Swing Mail-In Event Video DVD Order FoRm AFTER COMPLETING THIS FORM, HIT "PRINT" ON YOUR BROWSER BAR. Your Information Name: Street Address: City: State: Zip: Phone: Email: (required) DVDs will be available within 4-6 weeks after event. NUMBER OF DVDs............... Choose Video Event DVD - $45, plus $5 Shipping....$50 Workshop DVD - $25, plus $5 Shipping....$30 Event/Workshop Set - $60, plus $5 Shipping....$65 ............................................................Total Amount Enclosed $
Please make checks payable to "Becky Larson" If paying by credit card, please complete the information below. For security purposes, you must complete the credit card information by hand. Credit Card Payments - Processed through Pay-Pal(r)
Credit Card # - print Clearly
Expiration Date: MM/YY
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3-digit Security code on back of card
I authorize the above credit card for TOTAL purchases as indicated above: Signature:________________________________________________ PRINT THIS FORM FROM YOUR BROWSER and Mail to: Becky Larson...45369 Northport Drive, #3312...Macomb, MI 48044 For Security reasons, PLEASE CLOSE THIS BROWSER WINDOW AFTER PRINTING--your information will not be saved OR TRANSMITTED across the Internet.