Barlieb - Wallace Productions Order Form

	Barlieb · Wallace PRODUCTIONS, Ltd.
1680 Minesite Road Allentown, PA 18103 barwalprod@rcn.com (610) 395-7176 (800) 891-4898 fax (610) 395-8336

To order our DVDs or VHS tapes by check or money order, print this form, fill it out, and mail it to us with your payment in US funds to
Barlieb · Wallace Productions, Ltd.
1680 Minesite Road
Allentown, PA 18103

Ship to:

Name_____________________________________________

Address___________________________________________

City______________________________________________

State_____Zip__________Phone(____)_______________

Email_____________________________________________

Qty Title Price Total

And God Created Footlights 24.95

Brother - 4 for the Road 14.95

Fever 39.95

Get Ready 9.95

Metallic Aquatic Sonambient: Kinetic Tonal Sculptures 19.95

Pints, Pounds and Pilgrims 19.95

Poof... You're Dead! 39.95

Spirit of the Molly Maguires 29.95

Steelbound 29.95

To Live in Hope, To Die in Peace 59.95

Shipping and Handling: $5.00 first DVD or VHS tape, $2.50 each additional DVD or VHS tape

PA state residents add 6% sales tax

Total

Qty	Title	Price	Total
	And God Created Footlights	24.95
	Brother - 4 for the Road	14.95
	Fever	39.95
	Get Ready	9.95
	Metallic Aquatic Sonambient: Kinetic Tonal Sculptures	19.95
	Pints, Pounds and Pilgrims	19.95
	Poof... You're Dead!	39.95
	Spirit of the Molly Maguires	29.95
	Steelbound	29.95
	To Live in Hope, To Die in Peace	59.95


	Shipping and Handling: $5.00 first DVD or VHS tape, $2.50 each additional DVD or VHS tape
	PA state residents add 6% sales tax
	Total