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 (Best Buy!)

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

Entire Five Video Collection! Plus a Complete Set of Smart Cards!

Special Price--------------------$69.95

S/H --------------------------------6.95

Total ----------------------------$76.90

R.I. residents add 7% sales tax (R.I. Total $81.80)

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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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Please allow up to five days for your check to clear.