$25 International "PREVIEW DVD" Order Form

Customers in countries other than the U.S., Canada & Mexico may purchase a ``Preview DVD`` for $25 USD. 
The international preview fee is refundable upon your subsequent purchase of any Family Health Media title. 
Credit card pre-payment is required. It is not necessary to return the preview DVD to us.  

The ``Preview DVD`` contains the full length of each video. A screen title identifies all programs as ``For Preview Only.``

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Important: Enter a valid e-mail address. Receipts will be sent to this address.

*E-Mail:

*Phone

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Shipping Information

*Name:

*Address Line 1:

Address Line 2:

*City:

*State or Province

*Postal Code:

*Country

Your credit card will be charged $25

*Name on card

*Card Number:

No dashes or spaces please

*Expiration Month:

*Expiration Year:

*Credit card billing address

Where your statement is mailed

*City:

*State or Province

*Postal Code:

*Card Brand:

*Card security code

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