Thea Award DVD Order Form

Your Name:
Company:
Your Address
Ship to Address (if different):
Phone:
Fax:
Email:
13th Annual Thea Award DVD ($20 each):	Qty: Subtotal:
12th Annual Thea Award DVD ($20 each):	Qty: Subtotal:
Subtotal:	$
California state residents please add 8.25% tax	$
Grand Total:	$
Payment by Credit Card: You may contact TEA to process your credit card off-line.
Name on Card:
Credit Card Account #:
Expiration Date: