Name                   

Mailing Address 

City                      

State                         ZipCode

Email                   

Quantity   Video VHS                                       x  $19.95/ea +$3.50 S&H          $

Quantity   Video DVD                                      x  $29.95/ea +$3.50 S&H          $

Quantity   Log Book  001 Hermit Crab           x  $11.95/ea +$1.50 S&H          $

Quantity   Log Book  002 Diver                       x  $11.95/ea +$1.50 S&H          $

Quantity   Log Book  003 Shark                      x  $11.95/ea +$1.50 S&H          $

Quantity   Log Book  004 Wreck                     x  $11.95/ea +$1.50 S&H          $

Quantity   Key Chain                                        x  $4.95/ea +$3.50 S&H            $     

                                                                                                               Total Order  $

Credit Card M/C Visa   

Exp Date MM/DD/YY                

Should you wish not to use your credit card over the Internet, you may place your order by calling the number, or by mailing a check to:

Delfin Underwater Productions Inc.

234 West St. South Hackensack, NJ 07606

Tel: 1 (201) 487-4336

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