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To join, please fill out the form below, following the instructions carfully, then submit your application.


Please read and check your agreement. (If you do not check this box, your application WILL BE VOIDED!)

Yes! Please enroll me in the Columbia House DVD Club under the terms outlined in this advertisemen and send me the 4 DVDs I've indicated for 49 each, plus $1.99 each shipping and handling (total is $9.92). As a member, I need to buy just 4 more DVDs at regular Club prices within the next two years--and may cancel membership anytime thereafter. If I am not satisfied, I may return my introductory selections within 10 days, and owe nothing.

Please fill out the following:

Mr. Mrs. Ms.
Name:
Address:
City: State: Zip: Offer not available outside the United States.
Phone Number:

Send me these CDs:

Selection 1:
Selection 2:
Selection 3:
Selection 4:

DVD BONUS OFFER:
Also send me my first selection for $14.95 plus $1.99 shipping and handling, which I'm adding to my $9.92 payment (total is $26.86). I then need buy only 3 more DVDs (instead of 4) in the next two years:

Bonus Selection:

Have you ever bought anything by mail in the past?

Yes.
No.

How have you paid for your mail-order purchase?

Cash.
Credit card.
Check.
Money Order.

We need your email address so we can send you confirmation. We will not process any application without an email address.

E-mail address:
You will receive confirmation within a week. If you do not, contact us.


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