“Burying The Past” Order Form
**Please print, fill in, and send with your check

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Please Send Payment To:
Patrick Film/Video Productions
640 Parkview Drive
Park City, UT 84098

801-554-8640
(Make checks payable to Patrick Film/Video Productions)

Sold To:
Name:__________________________________
Address:________________________________
City:__________________State:_____________
Zip Code:_____________Phone:______________


Ship To:(if different than above)
Name:__________________________________
Address:________________________________
City:__________________State:_____________
Zip Code:_____________Phone:______________

Item & Price Quantity Cost
“Burying The Past” DVD
with special features $25 each-___________ $__________


“Burying The Past” VHS
$25 each– ____________ $__________


Total due $___________

*All prices INCLUDE SHIPPING

((To print, click on "file" then "print"))