Please fill out the following information and return to:

Deep Fork Community Action Foundation, Inc.
ATTN: HOMEBUYER EDUCATION
P.O. Box 670
Okmulgee, OK 74447-0670

(Please allow 3-5 weeks for delivery)

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NAME: __________________________________________________________________

ORGANIZATION NAME: __________________________________________________

MAILING ADDRESS: _____________________________________________________

CITY: __________________________________ STATE: ______ ZIP: ____________

TELEPHONE NO: __________________________ FAX: _______________________

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(Specify number of copies you are ordering)

I would like to order:

  ____Video#1   _____Video#2   _____Video#3   _____ Video#4 (VHS OR DVD)

  ____Video#5   _____DVD#1

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$7.95 Combined shipping on any two items

PAYMENT METHOD:  _____ Company Check/Money Order/Cashiers Check

                                          _____ Purchase Order No. (if used)

                                          _____ Visa   _____ Master Card


NAME: __________________________________________________

CARD NO: _______________________________________________

EXP DATE: ______________________________________________

SIGNATURE: _____________________________________________

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