Estamos Aquí (We Are Here)
Fax/Mail Order Form
All prices include Shipping and Handling
Allow 2 - 4 weeks for delivery
Please be sure to fill form completely, then print to fax or mail.
PROGRAM
Please make a selection
     QTY
"Estamos Aquí" - DVD for Individual Use $ 24.95  
"Estamos Aquí" - DVD for Public Screening $ 125.00  
BILLING INFORMATION SHIPPING INFORMATION (if different)
Credit Card
Cardholder Name
Card Number
Expiration
Security Code
Company
Street Address
Address (cont.)
City
State/Province
Zip Code
Country
Phone
E-mail
Name
Company
Street Address
Address (cont.)
City
State/Province
Zip Code
Country
Phone
E-mail
 
 
 

Fax this completed form to TELEDUCTION at (302) 429-7534
OR
Mail this completed form to:
TELEDUCTION,  954 S. Madison Street,  Wilmington, DE 19801
You may also mail order form with check or money order to above address.