Order Form

1) Please print out this order form and fill in all required information.

2) Make Check/Money Order Payable to John Coppa and mail to:

Smart Casino Gambling

P.O. Box 5472

Wakefield, R.I. 02880

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Special Offer!

(Circle DVD or VHS ---and also choice of videos)

---DVD-- or --VHS --(Circle Choice)

(Circle Choice) Blackjack--Craps--Baccarat--Roulette--TurntheTables--$24.95

S/H ---(one video)-----------------------------------------------------------------3.95

Total------------------------------------------------------$28.90

R.I. residents add 7% sales tax (R.I. total $30.65)

(Add $2.00 s/h for each additional video)

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3) Please Ship My Order To:

Name_________________________________

Address_______________________________

City________________State_____Zip_______

Phone / E-Mail _________________________

Please tell us how you found John Coppa's web site?

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