Ship To:
Your Name:_________________________________

Your Address1:_____________________________

Your Address2:_____________________________

Your City,St, Zip:_____________________________

Circle one:

I'd like to order 1 DVD :$ USD_____7.00_______

I'd like to order 2 DVD :$ USD_____13.00_______

I'd like to order 3 DVD :$ USD_____19.00_______

I'd like to order 4 DVD :$ USD_____25.00_______

I'd like to order 5 DVD :$ USD_____31.00_______

All Prices already include taxes, shipping and handling!

Please mail check or money order (on a U.S.A. drawn bank) made out to Jimmy D. Isom to:

MassillonProud.com
PO BOX 25
North Industry, Ohio 44707