The Stanford Prison Experiment: DVD/Video Order Form

Order Form for
Quiet Rage: The Stanford Prison Experiment

Please use the print button at the top of your web browser to print this form, and then fax or mail the completed form to the following address with a check or institutional purchase order made payable to "Philip G. Zimbardo, Inc."

Philip G. Zimbardo, Inc.
Department of Psychology
P. O. Box 20096
Stanford, California 94309-2996
Federal Tax ID: 95-2764164

Shipping Address:
Name__________________________________________________
Address________________________________________________
City_____________________ State_________ Zip Code_________
Country_______________________________
Phone________________________________
Email_________________________________
Today's Date___________________________

Quantity
Description
Total

______
DVD Subtotal ($100.00 for each copy):
$_____

______
Video Subtotal ($100.00 for each VHS copy
and/or $115 for each PAL version):
$_____

Shipping and Handling ($10.00 for U.S. and
Canada, $20.00 all other countries):
$_____

Sales Tax (California only, at 8%):
$ 8.80

Wire Fee ($15.00 if paying by bank wire):
$_____

Grand Total:
$_____

Method of Payment: _______________________
(Check or Money Order, drawn on U.S. Bank only)
Institutional Purchase Order No. _____________

Note: If wiring payment, please use the information below and notify Dr. Zimbardo by email at the address below so that he can watch for the wire transaction:

Zimbardo Email:

Bank Name: Wells Fargo Bank N.A.

Postal Address: Tressider Memorial Union, 2FL

Stanford, CA 94305

Bank Phone Number: (650) 855-7605

Bank ABA/Routing Code: 121000248

Bank Account Number: 0283-064343

Quantity	Description	Total
______	DVD Subtotal ($100.00 for each copy):	$_____
______	Video Subtotal ($100.00 for each VHS copy and/or $115 for each PAL version):	$_____
	Shipping and Handling ($10.00 for U.S. and Canada, $20.00 all other countries):	$_____
	Sales Tax (California only, at 8%):	$ 8.80
	Wire Fee ($15.00 if paying by bank wire):	$_____
	Grand Total:	$_____
Method of Payment: _______________________ (Check or Money Order, drawn on U.S. Bank only) Institutional Purchase Order No. _____________


Note: If wiring payment, please use the information below and notify Dr. Zimbardo by email at the address below so that he can watch for the wire transaction:
Zimbardo Email:
Bank Name:	Wells Fargo Bank N.A.
Postal Address:	Tressider Memorial Union, 2FL
	Stanford, CA 94305
Bank Phone Number:	(650) 855-7605
Bank ABA/Routing Code:	121000248
Bank Account Number:	0283-064343