First Name   

Last Name   

Business Name 

Mailing Address 

City     State

Postal Code     Country 

Telephone Number 

E-mail Address 

Number of DVD Sets Requested   
Unit Price $130.00 (includes all taxes and shipping)
Total (Unit Price X # DVD Sets)  

Comments/Special Requests/Handling Information    

If sending by mail,  complete the form, then print the form out and send a copy with your payment in the mail to the address below