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
TAX ID# 58-2667551

                    ORDER FORM ­ INSTITUTIONAL PURCHASE

Please print, sign and mail all pages of this order form to CVM.

Date:

Contact Name:

Institution:

Department:

Street:

City:

State or Country:                            Postal Code:

Telephone:                                   Email:

Shipping Contact and Address (if different):


Purchase Order No. (if applicable):

Description and Type of Venue (for example, college, archive, library):

ORDER
We are ordering one copy of the Jordan Belson: 5 Essential Films DVD @
$150, at the institutional rate which includes a limited educational license.

Shipping to (check one):
______ US address @ $5

______ Canadian address @ $6

______ Outside US and Canada, $8
TOTAL ORDER

One DVD                                        $150

Shipping cost (from page 1)                    _______

California addresses, add 8.25% tax             _______
($12.38) or provide evidence that you
are not required to pay state
sales tax (please attach)


              TOTAL COST:                      US$________

PAYMENT

   A. United States and Canada: Orders must be prepaid by US check,
      money order in US dollars, or credit card. Orders placed with a PO
      (on institutional letterhead with signature) which are not pre-paid
      may take up to 60 days for processing.

   B. International: All orders from outside the US and Canada must be
      pre-paid. Payment must be in US dollars, via credit card.


______ Visa

______ Mastercard

Name as it appears on card:

Account Number:

Expiration date:

Billing address if different than on page 1:


I authorize CVM to charge to the above credit card the amount of

_________ (from total cost above)


Cardholder signature: ___________________________________
LIMITED EDUCATIONAL LICENSE


The Jordan Belson: 5 Films DVD is sold subject to the following conditions:

1.    The DVD may be screened in a classroom, or used in a library or
      research collection of an institution.

2.    Public Performance rights are not granted; the DVD may not be
      exhibited publicly, commercially or theatrically. The DVD may not
      be exhibited in museum or gallery exhibitions without obtaining
      additional licenses.

3.    The DVD or any of its contents may not be broadcast, cablecast or
      webcast in any manner.

4.    The DVD may not be duplicated, copied, distributed or reproduced
      in whole or in part.

5.    The DVD may not be rented, licensed or leased to any institution or
      individual.

6.    The DVD may not be altered or excerpted in any way.

7.    Copyright notice: Films and images on the DVD are © Jordan
      Belson. DVD © The Center for Visual Music, 2007.


Licensee understands and agrees to the above terms, and agrees to
abide by the above conditions. In the event of any breach or default by
the Licensee, Licensee agrees to pay additional penalties and license
fees.

Licensee:___________________________________ (name of purchaser)

Signature:___________________________________

Date: _______________________________________



Exceptions to the above, 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. CVMaccess@gmail.com