Independence 72 Media – Sri Lanka America Association of Las Vegas

Purchase Independence 72 Media

PayPal - SLAALV

Order Form:

Purchase additional copies below by entering the Media Type/Quantity. After you complete the form, you will be redirected to PayPal to complete your order.

Available formats include:
Blu-Ray $22 / Event DVD $10 / Photo CD $10
($10 shipping & handling is included in the price)

Blu-Ray $22

Blu-Ray

Blu-Ray Quantity:

Event DVD $10

Event DVD

Event DVD Quantity:

Photo CD $10

Photo CD

Photo CD Quantity:

[hidden blurayhid “Blu-Ray”] [hidden eventdvdhid “Event DVD”] [hidden photocdhid “Photo CD”]

Contact Information:

First Name

(required)

Last Name

(required)

Contact Number

(required)

Mailing Address:

Address #1

(required)

Address #2

City

(required)

State

(required)

Zip Code

(required)