Order Form

 To place your order for Extreme Kauai DVD or VHS films, please fill out the following and submit.  You may also choose to print out and mail a check to: Birds In Paradise, Inc. dba Extreme Productions at 1768 Mei Place, Kapaa HI 96746.

Name:

Street Address:

City:    State:  Zip code: 

Phone: E-Mail:

I would like to buy this film in:  DVD@ $19.95:  

Qty:   Please add $3.85 for USPS Priority mailing (for up to 4 DVD or 2 VHS.) Total =

(total cost for 1 dvd= $23.80)

I would like to pay by credit card:

Visa     Mastercard      Card number  

Expiration date: January February March April May June July August September October November December Year:  2004 2005 2006 2007 2008 2009 2010  

*  If paying by money order please mail to address at top of this form.  If you have a discount code please enter here:

If you do not receive confirmation of receipt of this order within 48 hours please email us at: info@extremekauai.com