Royal Raymond Rife Zerozerotwo Productions

PRINTABLE ORDER FORM
IMPORTANT: Please use this form for all mail orders. The box at the bottom of this page will calculate your shipping
and total for you. You only need to type your mailing information in the box below; and use the calculator below that to add your total,
and then print this form for mailing.

When sending a Money Order: Ordering in Canada, please use a Canadian Money Order.
From outside of Canada, you will need an International Money Order - with funds in Canadian dollars.
Payable to: R. S. Montgomery
Send check or money order with printed Order Form to:
Shawn Montgomery, 23 Murray St., Brockville, Ontario, Canada K6V 2W5

THE RISE AND FALL OF A SCIENTIFIC GENIUS
The Forgotten Story of Royal Raymond Rife

Customer and Order Information:

Full Name:

Address:

City:

Province/State:

Country:

Zip Code:

Phone:

Date:

Email:

PLEASE FOLLOW THESE INSTRUCTIONS: To use this calculator, type only in the Quantity box. Choose Canada, USA or Overseas, and type the number of DVD's you are ordering. Then, in the box below called Grand Total, click your mouse. Your total will appear. To cancel, change the Quantity to "0" (zero) and click the Grand Total box again.

Shipping is calculated automatically
For each DVD: Canada $4.00 / USA $5.00 / Overseas $10.00

* Item Where Price Quantity Total

* DVD Canada $

* DVD USA $

* DVD Overseas $

Order Total

Shipping

Grand Total

After completing the form,
click on the print button

GO BACK TO ORDER PAGE

THE RISE AND FALL OF A SCIENTIFIC GENIUS The Forgotten Story of Royal Raymond Rife
Customer and Order Information:
Full Name:
Address:
City:
Province/State:
Country:
Zip Code:
Phone:
Date:
Email: