Distant Thunder Films Patron Order Form
Last Name:__________________________________________ First Name:______________________________________
Phone Number:_______________________________ E-mail:___________________________________________
Address:________________________________________________________________________________
City:_______________________________________________ State:________ Zip Code:________________
I am making a donation of a ___________________________.
-------------- (___) MONEY
-------------- (___) CONSTRUCTION MATERIAL(s)
-------------- (___) CAMERA/ VIDEO EQUIPMENT
-------------- (___) PROM/COSTUME
-------------- (___) ELECTRONICS
-------------- (___) SERVICES
--------------Donation Total $_________________________
Shipping Costs= $___________________________
---------------TOTAL: $___________________________
COMMENTS:___________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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