PAHO VIDEO ORDER FORM
in U.S. dollars
(PLEASE PRINT)

Name

Company

Address

              

City/State/ZIP

Telephone number

Fax number E-mail

E-mail

Reference Number= PI 009
 

  Title Quantity Unit
Price		 Total $




















Total-->
Please Specify:

Language:
English Spanish Portuguese French

System:
NTSC PAL Other

Format:
VHS Umatic Betacam SP

VHS: $ 35.00 ea.
Umatic: $ 75.00 ea.
Betacam: $150.00 ea.

Print, fill, and return this order form with payment to
PAHO
Office of Public Information (DPI)
525 23rd Street NW
Washington DC 20037, USA

Shipping and handling costs included in price.

Allow 3-4 weeks for delivery after order is received.

CHECKS MUST BE IN US$ AND DRAWN AGAINST A U.S. BANK

Make checks payable to:
Pan American Health Organization
(Include Reference Number PI009)