PuertoRicanMeals.com
	MAIL ORDER FORM
	Name:
	Address:
	Telephone #:
	E-mail address:
	Order Form: 10 DVD Box Sets
	Product Code	Description	Unit Price	Quantity	Amount
	Box Set	10 DVD Box Set	$49.99
	Product Discount Code :		Subtract Discount Amount
	United States Orders (Only) S&H			Add $13.98
	Priority Mail with Delivery Confirmation.			per Box Set
	Sales Tax (Ohio Residents Only)			Add 7.5%
	Add Totals			Total Amount
	Order Form: Individual Discs
	Product Code	Description	Unit Price	Quantity	Amount
	1	DVD Disc 1	$15.25
	2	DVD Disc 2	$15.25
	3	DVD Disc 3	$15.95
	4	DVD Disc 4	$15.25
	5	DVD Disc 5	$15.95
	6	DVD Disc 6	$15.95
	7	DVD Disc 7	$15.95
	8	DVD Disc 8	$15.95
	9	DVD Disc 9	$15.25
	10	DVD Disc 10	$15.95
	United States Orders (Only) S&H			Add S&H
	Priority Mail with Delivery Confirmation.			$2.50 per
				Disc
	Sales Tax (Ohio Residents Only)			Add 7.5%
	Add Totals			Total Amount
	Instructions:  Print & fill out the form.  Mail the form as well as the payment
	(U.S. payable Money Order). Once we receive your payment,
	please allow 2 – 4 weeks delivery (Delivery time includes a 10 day
	waiting period for payment to clear).
	Mail Form and Payment to:		Memories DVD Transfer, LLC
			P.O. Box 224
			North Olmsted, Ohio 44070