Video and Picture Request Form

To place an order or receive additional product information, complete and print the order form below. Mail the completed form to the address listed below or contact us directly.

RQ3    
4276 Decatur Drive    
Woodbridge, Virginia 22193

Photos & Videos

  703-730-3957

Please provide the following contact information:

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
**E-mail
   

For Class Videos, please provide the following ordering information:

QTY DESCRIPTION
 Class Video & Photo on DVD
 Class Video Only (DVD)

   Please indicate which class you are requesting a video for:

       

If placing an order, be sure to include your check or money order, paid to the order of:  RQ3

    

For more information contact customer service mailto:cindy@rescue3va.com

    

 

                                    Reproduction of photos or material from this website is strictly prohibited with out the expressed written consent of Rescue3Va.