Video Lesson Order Form

Send this form and your video to:                               
Irina Yastrebova
P.O. Box 901                      
Smoky Lake, AB, T0A 3C0
Canada

Name _______________________________________________________________________

Address ____________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Phone number _______________________________________________________________

E-mail address _____________________________________________________________

Comments ___________________________________________________________________

Video Lesson ..................................................... $50.00(CAN)


     O  Check or money order          Amount Enclosed: $                   
     O  VISA                                                                
     O  Master Card                                                         
     O  American Express                                                    
     O  Discover/NOVUS                                                      

Card number ______________________________ Expiration date ________/________

Date and Signature _________________________________________________________

Notice: The credit card number will be charged by AY Software Corporation in US dollars.