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Print this form, fill it out, and mail it with your payment to

CultTVman
PO Box 7041
Atlanta GA 30357-0041

YES! Please send me the following  products

Item

Quantity

Price

Total


 

 

 

 


 

 

 

 


 

 

 

 


 

 

 

 


 

 

 

 


 

 

 

 


 

 

 

 


Subtotal

 



NAME: ________________________________________

ADDRESS: _____________________________________

CITY _________________ STATE ______ZIP ________

COUNTRY ________________________

e-mail:______________________________________

Postage

 

6% Sales Tax (only Georgia residents)

 

Final
Total

 

Payment information: check or money order accepted.   Non US residents please use an international money order made out in US funds.     Payment should be made out to CultTVman.  Please allow up to 6 weeks of delivery.  Personal checks may delay order while I wait for the check to clear the bank.

Postage: Please use the shopping cart to calculate actual postage.