Bath Community Television

443-8387 4 Sheridan Road, Bath, Me. 04530 Fax 443-8361

Purchase Request Video or Audio Tapes DVD or CD's

 

 

Name _________________________________________Date _____/_____/_____

Address ___________________________________________________________

Home Phone__________________________________

All Tapes and CD's are $ 10.00 each.

Date Event Occured ______/_______/_______ Day of Week__________________

Name Title of Event ____________________________________________________

I wish to purchace ____Video Tapes ____Audio Tapes ____DVD's ______CD's $_____

Date Event Occured ______/_______/_______ Day of Week__________________

Name Title of Event ____________________________________________________

I wish to purchace ____Video Tapes ____Audio Tapes ____DVD's ______CD's $_____

Date Event Occured ______/_______/_______ Day of Week__________________

Name Title of Event ____________________________________________________

I wish to purchace ____Video Tapes ____Audio Tapes ____DVD's ______CD's $_____

Date Event Occured ______/_______/_______ Day of Week__________________

Name Title of Event ____________________________________________________

I wish to purchace ____Video Tapes ____Audio Tapes ____DVD's ______CD's $_____

Total Due when picking up Tapes Disks $___________

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Office Use Only

Tape# _______ Owner ____________ Dub#________Dub Machine_______________

#Copies_______ Operator ________ Completed_______________________________

bc tv 707 07/06