Prairies Edge Goose Club, LC
Video Order Form

please print out and complete this form

Payment Options (check one)

Visa Mastercard (for faxing or mailing orders)

Credit Card # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Name on Credit Card ________________________________________________

Expiration Date ___________________

Signature ________________________________________________________

Check or Money Order enclosed (please make payable to "Paddles Down Product Co")

Ship to: (if using credit card - must be the same as credit card billing address!)

Name: _______________________________________________________

Address (no PO Boxes Please - UPS can't deliver) _____________________________

City __________________________ State_________ Zip ________________


__________________________________ Date ____________ Phone (____)____________________

Authorized signature (required for shipping)

Fax or Mail to - "Paddles Down Product Company" Attn: Order Dept .......... Fax # (515) 276-3507

Mailing Address: 308 SW Park Ave / Des Moines, IA / 50315


I would like to order the following videos...

(Please X the next to the items you want...)

Video #1 - "A Professionals View on Mastering the Short Reed Canada Goose Call"

Qty ____ @ $13.00 = ___________

Video #2 - "Blow the Beaks Off Em..."

Qty ____ @ $13.00 = ___________

Video #3 - "Blow the Beaks Off Em II..."

Qty ____ @ $13.00 = ___________


Total Qty ____ Price ___________

Shipping & Handling + $3.00

Extra S&H for O/N +$15.00

+ Iowa Res add 6% sales tax

Total Due ____________

THANKS FOR YOUR ORDER!