PWP

PO BOX 5002,

ST. CATHARINES, ONTARIO

CANADA

L2R 7T4

MAIL

ORDER FORM

Name: __________________________________________________________________

Address: _________________________________________________________________

City: ____________________________State/Prov:_______________ Zip: _______

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YOU CAN WRITE OUT YOUR ORDER ON A SEPARATE SHEET OF PAPER

PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO: PWP
WRITE IN YOUR DVD ORDER IN THE BLANK SPACE BELOW
[ ] $US
[ ] $US
[ ] $US
[ ] $US
[ ] $US
[ ] $US

SUBTOTAL

 $

PACKAGING ($2.00)
 $2.00

[ ] CHECK [ ] MONEY ORDER FOR THE PRESENT, PLEASE NO US POSTAL MONEY ORDER TOTAL AMOUNT OF ORDER