Bridge to the Tango Swing Videos Order Form

Item # Quant. Description Price Total ________ ________ ________________________________ ________ ________ ________ ________ ________________________________ ________ ________ ________ ________ ________________________________ ________ ________ ________ ________ ________________________________ ________ ________ ________ ________ ________________________________ ________ ________ ________ ________ ________________________________ ________ ________ Sub-Total ________ Discounts ________ Mass. residents add 5% sales tax ________ Shipping & Handling ________ Grand Total ________ Payment Method: check  money order  VISA  MC Full Name on Card: __________________________________________ Card Number: ____________ - ____________ - ____________ - ____________ Expiration: ________ / ________ Billing Address: Name: __________________________________________________ Address: _______________________________________________ City: ____________________________   State: _______ Zip: ________________   Country: __________________ Home Phone: ____________________________________    Work Phone: _____________________________________    Email: __________________________________________ Shipping Address (if different): Name: __________________________________________________ Address: _______________________________________________ City: ____________________________   State: _______ Zip: ________________   Country: __________________ Home Phone: ____________________________________    Work Phone: _____________________________________    Please check our shipping chart when filling out your order. Checks payable to: Daniel Trenner, 46 Graves Ave., Northampton, MA 01060   info@danieltrenner.com | 1-877-99Tango