Video Request Form

The Nutcracker Suite ~ DVD ORDER FORM

Cost:  $33/each (DVD will be mailed directly to you.)

Return to:  Bedford Dance Center, 172 Route 101, Bedford, NH, 03110

NAME:_______________________________________________________________________________

ADDRESS:___________________________________________________________________________

                      __________________________________________________________________________

PHONE:_______________________              E-Mail:_________________________________________

TOTAL VIDEOS ORDERED________

AMOUNT ENCLOSED $___________

(Checks should be made payable to Bedford Dance Center)