Video Purchasing Form

To order a SERIES or an individual videotape from the CenterNet Library, please fill out the following form and click the SUBMIT button at the bottom of this page or print this page and fax it to (703) 619-9536.  If you would like to view the series information again or cannot remember the name of the individual program you would like to purchase, you may find these titles in the NIH and/or NURSING schedule, the POLICY PROGRAMS schedule, or in CenterNet's PAST PROGRAMMING Library (which will include live special events after they have been made available on tape).

Please select the type of program you are interested in purchasing:

Please choose VHS/Videotape or CD-ROM:
(will send VHS unless specified below, only Bench to Bedside available on CD-ROM)

If purchasing individual videotape(s) and not a series, please enter the title(s) here:

Shipping Information Institution Name:
Your Name: Title:
Address:
City: State: Zip Code:  
Telephone: Fax:
Email: Country:  

Payment Options (choice of three) 1) Check, made payable to Healthcare Management Television, Inc.

2) Purchase Order #
    Please fax or mail copy of purchase order..

3) Credit Card  (select one)  Visa  MasterCard  Discovery  AmEx
    Card Number: Exp. Date:
    Complete Name on Card:
    Billing Address (if different):
    Total Amount of Purchase on Card:   

Special Shipping Requirements:
*All Shipping & Handling Prices are included in the cost, except for any orders shipped internationally. International Orders add $25.00 S&H.
Privacy Policy

*If you are printing this form to fax, please fax to (703) 619-9536
*If you are printing this form to mail, please mail to:
 Healthcare Management Television, Inc.
 P.O. Box 7441
 Alexandria, VA 22307
*If you are submitting this form electronically and are satisfied with the information you have entered, please click the SUBMIT button below.