Please charge each month's shipment to my credit card:

CC# ______________________________________________ Expires __________________


Signature __________________________________________________________________

Name on Card_______________________________________________________________

Your Name__________________________________________________________________

Address____________________________________________________________________

___________________________________________________________________________

City _________________________________State _____________ Zip ________________

Phone _____________________________ Fax ____________________________________

Email_______________________________________________________________________

Yes! Sign my friend up for the Visionary DVD Club. I understand that my credit card will be charged $20 each month for this service. I understand that I may cancel this service at any time. (If shipping is to a non-USA address, I authorize US $27 per month.)

Your Friend's Name ___________________________________________________________

Address ____________________________________________________________________

___________________________________________________________________________

City ______________________________________State _____________ Zip ___________

Phone ________________________________ Fax _________________________________

Email_______________________________________________________________________