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Videotape Series Order Form

Please complete this form; print, sign it,
and send it to:
California State University, Hayward
Extended & Continuing Education
25800 Carlos Bee Blvd
Hayward CA 94542-3012
OR Call: Bay Area, (510) 885-3605
Call: Outside Bay Area, 1-800-730-2784
Fax: (510) 885-4817

Please have your Visa or MasterCard ready when calling.

Name
Address 1
Address 2
City State Zip Code
Day Phone Ext :
Evening Phone Ext :
E-mail
Please check ONE
Enclosed is a check for $209.95 (includes shipping and handling) payable to CSUH
Charge $209.95 (includes shipping and handling) to my Visa
Charge $209.95 (includes shipping and handling) to my MasterCard

Visa/MasterCard #: - - - - Expiration Date:
PRINT Cardholder Name:

Signature: __________________________________________________
** Full payment must accompany this form.
For Office Use Invoice Cash Ck/MO:
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