“Burying The Past” Order Form
**Please print, fill in, and send with your check

Please Send Payment To:
Patrick Film/Video Productions
University of Utah Film Division
375 South 1530 East
Salt Lake City, UT 84112-0380
801-581-6900
(Make checks payable to Patrick Film/Video Productions)

Sold To:
Name:__________________________________
Address:________________________________
City:__________________State:_____________
Zip Code:_____________Phone:______________

Ship To:(if different than above)
Name:__________________________________
Address:________________________________
City:__________________State:_____________
Zip Code:_____________Phone:______________

“Burying The Past” VHS $25 each–QTY:__________ $__________

"Burying The Past" Movie Poster $10.00 QTY:_______ $_____________

Total due $___________

*All prices INCLUDE SHIPPING

((To print, click on "file" then "print"))