Lolli-Pops Order Form

Please print this page and use as an order form.
US orders only at this time.

Name (Please Print):_________________________________________________

Address:_________________________________________________________

City:_____________________________ State:______ Zip:_____________

Home Phone: (____) ________________________

Business Phone: (____) ________________________

E-Mail:_____________________________________

[ ] VHS ($20/each) _______ (Qty) x $20 = ________

[ ] DVD ($25/each) _______ (Qty) x $25 = ________

• For US orders only, please add $4.00 S&H. For international orders,
  please contact us for shipping and handling rates.
• NY Residents please add 8.625% sales tax ($1.73 per VHS tape and $2.16 per DVD))
  
• Please allow 4-6 weeks for delivery.
  
  TOTAL = ________

[ ] I have enclosed a check or money order made payable to:
Mister Maestro, Ltd.

Please charge my:
[ ] Visa    [ ] MasterCard    [ ] American Express

Card Number:__________________________________________ Exp:_____/______

Name:_______________________________________________
(as it appears on card)

Signature:____________________________________________

MAIL PAYMENT AND ORDER FORM TO:
Mister Maestro, Ltd.
14 Penn Plaza
Suite 1100
New York, NY 10122

For more information, please call (646) 230-6684