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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:___________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________