Lee Jay Nelson Merchandise Order Form

The THIS IS THE MOMENT CD is available for $10.00 and
a shipping & handling fee of $3.50

To purchase, make your check or money order for the amount of $13.50 payable to: Lee Jay Nelson

________

The LOOSE AS A GOOSE DVD is available for $15.00 and a shipping & handling fee of $3.50

To purchase, check or money order for the amount of $18.50 payable to: Lee Jay Nelson

_________

THIS PAGE AND YOUR PAYMENT ARE TO BE SENT TO THE FOLLOWING ADDRESS:

ALLOW 3 TO 6 WEEKS DELIVERY

Lee Jay Nelson

4900 Brittany Drive South
# 1705
Saint Petersburg Florida, 33715

Phone: (727) 742 - 1808

Email : leejaynelson@verizon.net

Print out this form and Submit with Payment to address listed to the left:
Your Name:
Your Phone:
Your Address:
Your Email: This is the Moment CD: $10.00 each + $3.50 S/H Loose As a Goose DVD: $15.00 each + $3.50 S/H	Quantity: Quantity: TOTAL PAYMENT ENCLOSED:
Comments:

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