Audio / Video Tape Order Form
993 W. 1800 North, Pleasant Grove, Utah  84062
Remit in U.S. Funds Only   Make checks payable to USPA
or you may call the Utah office with your credit card order at: 1-801-785-7416

Open Printable Version of This Form (Word Document)

Please send requests for the 2006/2007 DVD media to:

USPA
409 Marquette Dr.
Louisville, KY 40222

Phone: (502) 429-6600
Fax: (502) 425-4924

Name: ______________________________

Street Address: ____________________________________________

City: ________________________   State: _____   Zip: __________

Phone: Area Code (_____) ___________________   Country: ______________________

Paid by:  ___ Check   ___ Money Order   ___ VISA   ___ MasterCard

Card No: ____________________________   Exp. Date: ___ / ___

Signature: _______________________________________________

(Our mailing list is confidential, not released to any others.)

NOTE: Shipping is by US Mail (Media Class).