RADIO FOR PEACE INTERNATIONAL

PROGRAM TAPE ORDER FORM

COMPLETE, SIGN, AND RETURN THIS FORM WITH YOUR CHECK OR CREDIT CARD NUMBER
PLEASE TYPE OR PRINT CLEARLY.

Mr./Ms.
First Name _______________________________________________________________

Last Name ________________________________________________________________

Address __________________________________________________________________

__________________________________________________________________________

City _________________________________  State/Province ___________________

Postal Code _______________  Country _____________________________________

Telephone (home) ___________________  Telephone (work) ___________________

Fax ____________________  e-mail address _________________________________

Method of Payment: [  ]Check  [  ] VISA [  ] MasterCard

Card Number________________________________ Expiration Date___________
                                          
DATE                                              SIGNATURE (required for credit card purchase)