Pay-By-Mail Form

Name _____________________________________

Address______________________________________

_____________________________________________

_____________________________________________

Phone Number ________________________________

eMail Address __________________________________________

Item Ordered

     [ ] VS Song-Vault DVD Burner  $289.95

 [ ] RACK MOUNT VS Song-Vault
DVD Burner  $325.95
    
Shipping & Handling
[ ] US $30     [ ] Canada  $45    [ ] International  $60

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

Select SCSI Cable Needed:
[ ] DB25    [ ] 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.