Advincula DVDs Order FormSuccess Information Services___ Enclosed is my check or money order (payable to Success Information Services), or credit card order for $197. (Louisiana residents add $7.88 for sales tax). ___ Charge my: Visa Mastercard Card Number: ____________________________ Exp. Date: ______________ Signature: __________________________________________ Print Name: __________________________________________ Address: __________________________________________ City: _____________________________ State: _________________ Zip Code: _______________________ Country: __________________________________ Date of Birth: _____________________________________ Telephone: __________________________________________ Fax Number: __________________________________________ E-Mail: __________________________________________ 1-985-674-3595 Or Print and Mail This Form To: Success Information Services 4420 HWY 22 Mandeville , LA 70471 Return to Advincula Videos |