The Ultimate AVI CD -- Order Form

1. User information (please PRINT):

Name: ___________________________________________________________
Address line 1: _________________________________________________
Address line 2: _________________________________________________
City: ___________________ State: _____________ ZIP: _____________
Country (if other than USA): ____________________________________
Phone number: (___)______________ Date (MM/DD/YY): ____/____/____
Email address: __________________________________________________

2. Payment and fees:

Fees are in US dollars, please do NOT send cash. Checks and money 
orders must be made payable to TJ Falls. International orders must add $2.

__ Enclosed check or money order

3. Your order:

The Ultimate AVI CD................Quantity: ______  $15 ea.
International Order (Outside 48 US States).......... $2

Total....................................... $_________


4. Mail this form together with payment to:

   TJ Falls
   The Ultimate AVI CD
   P.O. Box 4851
   Covina, CA 91723
   USA