Video Order Form

Instructions: For each video you wish to order, please do the following:

1. Select "Preview" or "Purchase" price. (The preview amount will be credited toward your purchase if you decide to keep the video. Note: all returns must be post-paid and In good condition.)
2. Enter the quantity for each video desired.
3. For "Breaking Point" or "Survival and Beyond", be sure to indicate your format preference (VHS or DVD).

As you fill out the form, the totals at the bottom (including shipping charges) will automatically update. If you don't see any totals, clicking directly on the summary fields should reveal the correct amounts.

When finished, print out this page and mail it to us along with a check or money order in U.S. funds. Send to this address:

If you have further questions, please contact us.

To clear the form and reset all buttons, click .

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Note: all prices are in U.S. funds.

Title	Length	Select Price	Price	Format	Qty.	Total
Breaking Point	25 min.	Preview Purchase		VHS  DVD
Changing Perceptions	25 min.	Preview Purchase		(VHS only)
The Generation Connection:
Consolidated version	55 min.	Preview Purchase		(VHS only)
Split version	55 min.	Preview Purchase		(VHS only)
A Need to Connect	15 min.	Preview Purchase		DVD
Perceptions of Abuse	25 min.	Preview Purchase		DVD
One To One	25 min.	Preview Purchase		(VHS only)
Reach Out For A Friend	26 min.	Preview Purchase		(VHS only)
Survival and Beyond	30 min.	Preview Purchase		VHS   DVD
Where Do I Fit In?	22 min.	Preview Purchase		(VHS only)
Who Am I?	25 min.	Preview Purchase		(VHS only)
Young At Heart	25 min.	Preview Purchase		(VHS only)
Subtotal:
Shipping and Handling: $10 for one title; $12 for two or more titles
TOTAL (U.S. funds; tax is included)

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Name:
Organization:
Address:
Province/State:		Postal Code/ZIP:
Phone #:
Email:

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Please print out and mail this form, along with your payment, to:

Wise Owl Productions
P.O. Box 1656
Blaine, WA 98231