BCT- Customer Service Online

MULTIMEDIA ORDER FORM

To order videos or slideshows, simply print and complete the order form below. If paying by credit card, please fill in the required information. If paying by check or money order, indicate so where asked, make payable to
Burlington County Times, and mail or deliver to:

Burlington County Times
Multimedia requests
4284 Route 130, Willingboro, NJ 08046

Please note: * Denotes required information.

First Name:*

Last Name:*

E-mail Address:*

Phone (day):*

Phone (evening): (if different)

Example 555-555-5555

Street Address:*

Apt.# or P.O. Box: (if applicable)

City:*

State:*

Zip:*

	I will mail or drop-off check or money order
	Please charge my Credit Card

Credit Card Type:

	Visa
	MasterCard
	American Express
	Discover

Credit Card Number:

(Example: xxxx-xxxx-xxxx-xxxx)

Expiration Date:

(Example: 12/08)

If different than above, enter information as it appears on credit card.

Name:

Address:

City:

State:

Zip:

MULTIMEDIA SLIDE SHOWS & VIDEOS ON CD
$39.95 each**

Name of multimedia show:

Number of CDs ordered:
@ $39.95 each = Total Cost

Please Mail
I will pick-up at: Willingboro

For questions or more information, please contact
Ellen Cauthen at 609-871-8153 or at
ecauthen@phillyburbs.com

Please note:
* Denotes required information.
** For use by other media, please call 609-871-8083