Fax to 816-891-9118

Name _______________________________________________________________________

Shipping Address (no PO boxes please)

____________________________________________________________________________

____________________________________________________________________________

City _____________________________ State/Prov __________ Zip/PC _________________

Country _____________________________ Daytime Phone (______)___________________

Smiling Faces w/New Orleans Promo (DVD) No. of DVDs _____ x $30.00 each =  $_______

                                                                                        + 7.975% sales tax = $_______
                                                                                        (Missouri residents)

                                                                                                 Total Enclosed  $_______

Form of Payment:  ____Check   ____ MasterCard    ____ Visa  ____ Discover    ____ AmEx

Credit Card No. __________________________________________ Exp. Date ____________

Signature ___________________________________________________________________
(as it appears on card) (allow 2–3 weeks for processing)