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PERSONAL
CONTACT INFORMATION |
Refer to our
privacy policy for any questions you might have regarding
the information you submit to WKTV.
* denotes
a required field |
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* Name: |
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* Address: |
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City, State, Zip: |
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* Phone Number: |
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Email Address: |
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* Program Name/Date Aired (if
applicable): |
Sorry,
individual fights cannot be ordered. Only the full
night's card is available as a video. |
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*
Payment Amount &
Media Type: |
$
20.00 WKTV provides VHS Tape
$
20.00 WKTV provides DVD-R |
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* Payment Type: |
note:
***if you chose CASH or
CHECK as your method of payment, you will need to drop that
off, in person, to the WKTV broadcast studios in Wyoming,
Michigan.
***if you chose a credit
card as your method of payment, you will need to fill in the
appropriate information below. |
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FOR CREDIT CARD
PAYMENTS ONLY |
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Credit Card #: |
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Expiration Date: |
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Security Code: |
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Card holder's name: |
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CREDIT
CARD BILLING ADDRESS INFO |
** only if
paying with a credit card & is different from contact
information provided above ** |
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Name on card: |
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Address: |
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City & State: |
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Zip & Country |
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I certify, under oath, that I am the legitimate card holder of
record
ADDITIONAL COMMENTS
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