The Roland Collection
Order Form - USA





  Please use an alternative form for orders from countries other than the USA.

Please print out this page now!

 

  Bill to   Ship to
organization   organization  
department   department  
address   address  
city   city  
area/code   area/code  
country   country  
telephone   telephone  
fax   fax  
email   email  
date   date  
purchase order number   for the attention of  
for the attention of      

Is the order for private [  ] or institutional [  ] use? (please tick box)

 

catalog number title Quantity required price per title total
16mm film VHS video
           
           
           
           
           
           
           
           
           
 

Subtotal

  

shipping and handling

  

total

  

grand total

  

 

Shipping and handling - USA
Film sale @ $11 Video preview @ $7
Film rental @ $16 Books @ $7
Video sale @ $7 Resource guide @ $8
8 or more @ $3.50  

 

payment by Access O     Visa O     Mastercard O     American Express O
credit card number _ _ _ _     _ _ _ _     _ _ _ _     _ _ _ _    expiry date    __ / ____
cardholder's name _________________________________________

 

cardholder's signature

 

_________________________________________

 

Please send your order to :

UK and Worldwide USA only
   
The Roland Collection
Peasmarsh
East Sussex
TN31 6XJ

Telephone: 01797 230 421
Intl: +44 1797 230 421
Fax: 01797 230 677
Intl: +44 1797 230 677
Email: sales@roland-collection.co.uk 		The Roland Collection
22-D Hollywood Avenue
Ho-Ho-Kus
New Jersey 07423

Telephone: 201 251 8200
Fax: 201 251 8788