First Name
Last Name
Phone (412) (555-5555)
Email Address
Email Address Verification
Address
City
State
Zip Code
Number of Copies — $15.00 + 7% Sales Tax
Delivery Option
If having the DVD mailed, please leave the next 4 fields blank.
I am a
Please select which school to deliver to
Full-time/Homeroom — Teacher’s Name
Example — Mrs. Welsh
Fulltime/Homeroom — Room Number
Example — 204
Payment Options:
Mail Checks to: A $35.00 processing fee is added to all returned checks.
LG3 Entertainment, LLC.
1613 Brinton Ave
North Braddock, PA. 15104
In memo line please input: WH Dancing with the Teachers DVD
Total Amount
Example $15.00(DVD) + 7%(Sales Tax) + $5.00(Shipping) = $21.05
Please Note:
Delivery to schools will not be honored after January 31, 2009
Orders after January 31, 2009 must be delivered via USPS.