VIDEO LIBRARY ON-LINE ORDERING FORM

IF USING REGULAR MAIL Address All Orders and Inquires to:

ATTN: Video Library
National Safety Council, California Chapter
4553 Glencoe Avenue, Suite 150
Marina del Rey, CA 90292

Item no.
Title
Purchase
Rental
Date of Planned Use
Please allow a week between order date and date of planned use. Requests for date of planned use shorter than 7 days from order date may result in higher shipping and handling charges.

Ship To:

Name
Organization
Address
City
State
Zip
Telephone
Email