Bullfrog Films Order Form

For credit card orders, please PRINT and MAIL this form, or
For Fastest Service
Call TOLL FREE (800) 543-FROG (3674)
or FAX (610) 370-1978
Bullfrog Films
Box 149, Oley PA 19547
(610) 779-8226

  
#1 PREVIEW* PURCHASE RENT FORMAT: 
   TITLE: PRICE: DATE NEEDED:
  
#2 PREVIEW* PURCHASE RENT FORMAT: 
   TITLE: PRICE: DATE NEEDED:
  
#3 PREVIEW* PURCHASE RENT FORMAT: 
   TITLE: PRICE: DATE NEEDED:
  
#4 PREVIEW* PURCHASE RENT FORMAT: 
   TITLE: PRICE: DATE NEEDED:
  
#5 PREVIEW* PURCHASE RENT FORMAT: 
   TITLE: PRICE: DATE NEEDED:
  
#6 PREVIEW* PURCHASE RENT FORMAT: 
   TITLE: PRICE: DATE NEEDED: 
  
* PREVIEWERS                                    POSTAGE & HANDLING
  (Pay only return insured postage.)           Bullfrog will pay shipping
                                               on all PREPAID orders. 
                                               Otherwise include $5 per 
                                               cassette and $7 per 16mm
                                               film ($10 for films over 
Purchase Order Number                          40 min.)
                         
                                                PA add 6% Sales Tax
Please send me e-mail                          
    about new releases.                         TOTAL

Your Name
Title/Department
Institution
Address
City State ZIP
Phone
E-mail

Shipping Address -- if different:
Your Name
Title/Department
Institution
Address
City State ZIP
Phone

Billing Address -- if different:
Your Name
Title/Department
Institution
Address
City State ZIP
Phone

Mastercard or Visa (for fax or mail orders; will not be sent over the Internet):

Card Number______________________________  Expires:____________________

Name On Card:______________________________

Signature:_________________________________