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CARD #  
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Expiration Date (Month) ____     (Year) ____  
Card Holder Name  (please print) _________________________________  

Authorized Signature: 

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Kickbox I and Kickbox II - 2 Video Set
  Quantity:  _____          Price:   $29.95 (Save $5.00)

Kickbox Video Series Gift Set - 3 Videos
  Quantity:  _____          Price:   $44.95 (Save $10.00)

Cardio Athletic Kickbox Instructor Series I
  Quantity:  _____          Price:   $16.95 

Cardio Athletic Kickbox II - Play Hard, but Play Safe 
  Quantity:  _____          Price:   $16.95   

VHS PAL For Europe, United Kingdom, Australia, etc: Add $3.00 per video 
  Quantity:  _____          Price:   $3.00   

Subtotal (Price x Quantity)        ____  
Sales Tax (Calif. residents add 8.0%)____  
USA Shipping (1 Video)       $4.30 (International Shipping Add $4.00)

Add $1.00 shipping for  
each additional video               ________  

TOTAL                  $________    

Name:   ______________________________  
Address:   ____________________________   
Address:   ____________________________   
City/State/Zip:  ________________________   
Country:   ____________________________   
Phone:  ______________________________   
Email:   ______________________________   
Date:    ______________________________  

Please send payment to:  
Behind the Scenes Fitness  
65 Washington Street, Suite 296  
Santa Clara, CA 95050  (United States)
phone:   1-408-244-4895 

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