Pay-By-Mail Form

Name _____________________________________

Address______________________________________

_____________________________________________

_____________________________________________

Phone Number ________________________________

eMail Address __________________________________________

Item Ordered

      [ ] RACK MOUNT VS Song-Vault
DVD Burner  $325.95
    
Shipping & Handling
[ ] US $35  [ ] Canada  $50   [ ] International  $70

Product Total  $_______ + Shipping  $______ 
= Total  $________

Select SCSI Cable Needed:
[ ] DB25  (Choose this if you are connecting directly to your 2480)
  [ ] SCSI-2    [ ] SCSI-3
Visit http://vs-song-vault.ungo.net/SV-DVD-US.htm to determine your cable needs.

Send Cashier's Check, Bank Check, Money Order,
or International Money Order (payable in US funds)  Payable to:

LaCroix Enterprises
PO Box 968
Newport OR 97365

Please Print Out This Form and Include with Payment.