Center for Visual Music 453 S. Spring Street, Suite 834 Los Angeles,…

Center for Visual Music
453 S. Spring Street, Suite 834
Los Angeles, CA 90013
213-683-1514
CVMaccess@gmail.com

           PRE-ORDER FORM ­ PURCHASE FOR PRIVATE HOME USE

Please print, sign and mail this order form to CVM with payment.

Date:

Name:

Street:

City:

State or Country:                            Postal Code:

Telephone:                                   Email:

Shipping Address (if different):

______ Check if you wish to be added to the CVM mailing list to be
notified of future DVD releases, and our other programs and activities.

ORDER
I am pre-ordering the Jordan Belson: Five Essential Films DVD (NTSC,
Region Free) @ $25, at the private home use rate.

_____ DVDs at US$25 each                     $________

California residents add 8.25% tax        ________
 ($2.06 for each DVD)

Shipping to (check one):
______ US & Canadian addresses @ $5
______ Outside US and Canada, add $7 for first DVD, plus $1 for each
additional DVD ordered

                          Shipping cost        ________

              TOTAL COST:                   US$________
PAYMENT

_______ Check or Money Order (US dollars only), included with order

_______ Payment via credit card ­ Visa or Mastercard (please note, we
don't accept American Express)

Card No. ______________________________________ Exp. Date ___________

Name of Cardholder ________________________________________________

Billing address (if different from shipping address on page 1):



I authorize CVM to charge to my credit card the amount of $___________.
I am purchasing the Jordan Belson DVD(s) for my own personal use only,
and agree not to exhibit the DVD publicly, commercially or theatrically,
on the internet, in museum or gallery exhibitions, or for broadcast or
cablecast. I agree not to copy, duplicate or distribute the DVD or its
contents in whole or in part.



Purchaser/card holder (print name):___________________________________

Signature:___________________________________

Date: _______________________________________




Exceptions to the above uses, or additional licenses, may be requested
only in writing to The Center for Visual Music, 453 So. Spring Street, Suite
834, Los Angeles, CA 90013.