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    Order Form



    Quantity _____ Subtotal ___________

    Audio, DVD and Video Purchase 
    Tape Title

    Audio       DVD      

    Video
    ____________________________________________________ _________ _________ _________  
    ____________________________________________________ _________ _________ _________
    ____________________________________________________ _________ _________ _________
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    ____________________________________________________ _________ _________ _________
     
    Price Subtotal:
    __________

    Video Rental  (Please complete this section and sign rental agreement if you are renting tapes)
    Tape Title Show Date Fee
    ____________________________________________________ __________________ _______________________
    ____________________________________________________ __________________ _______________________
    ____________________________________________________ __________________ _______________________
    ____________________________________________________ __________________ _______________________
    ____________________________________________________ __________________ _______________________
    ____________________________________________________ __________________ _______________________
     
    Subtotal:
    _______________________

    Rental Agreement

    To keep rental and purchase prices as reasonable as possible, it is the Family Center’s policy not to permit previewing, since each use of the tape shortens its life. However, if you are planning to purchase a tape, you may pay the rental fee for the tape to preview it. The rental fee will be deducted from the purchase price if you decide to buy the tape. Clinical tapes may only be rented.

    Please order at least three weeks prior to the desired showing date.

    This rental agreement must be signed and returned to the Bowen Center before tapes will be released. Please fax to (202) 965-1765.

    • Clinical tapes will be shown only to professional audiences and the confidentiality of the families on the tapes will be protected.
    • Tapes will not be reproduced in any manner (including sound track reproduction). The Family Center tapes are copyrighted. Any reproduction of material in them is a violation of copyright law.
    • Tapes will be played on machines in good working condition so they will not be damaged.
    • Tapes will be used for one showing only, and will be returned promptly after use, insured for $200.

    I agree to the above rental terms. Signature:_______________________________________ Date:___________________

    Shipping and Handling

    US Priority Mail    
    Federal Express  Please call us for exact rates.
    United States:
    10% of total order
     
    United States:
    $ 25.00+
    Canada and Mexico:
    15% of total order
       
    Canada and Mexico:
    $ 35.00+
    Outside North America:
    Fed Ex only
       
    Outside North America:
    $ 50.00+
             
    Please allow two weeks delivery.  
    Shipping and Handling:_______________________
         
       
    TOTAL AMOUNT DUE:______________________

    Payment
    Payment is due with the order. Please pay by check or credit card. Outside the US, credit card only, please.
    Make checks payable to The Bowen Center.
     
    Type of card (please circle): Visa / Mastercard    
      _______________________________________ ___________________________
      Credit Card Number Expiration Date Signature
    Bill to:
    Name:
    _________________________________________________________________________
    Organization:
    _________________________________________________________________________
    Address:

    _________________________________________________________________________

    City, State, Zip, Country:
    _________________________________________________________________________
    Daytime Phone:
    _________________________________________________________________________
    E-mail:
    _________________________________________________________________________

    Check if mailing address is same as billing address
    Send to:
    Name:
    _________________________________________________________________________
    Organization:
    _________________________________________________________________________
    Address:

    _________________________________________________________________________

    City, State, Zip, Country:
    _________________________________________________________________________
    Daytime Phone:
    _________________________________________________________________________
    E-mail:
    _________________________________________________________________________

    If you have questions about your order, please contact Kathy Vlahos @ 202-965-4400 x 23 or kvlahos@thebowencenter.org


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