• Name* First Last

• Address* Address City State Zip

• Phone* (###-###-####)
• Email
• DVD(s) Requested* Title Quantity
• Title Quantity
• Title Quantity
• I would like to pick up my DVD(s) at:
  Mainstreet Communications Melrose Telephone Please mail my DVD(s) to me
• I plan on paying with:
  Cash Credit Card Check
• I am a DTV Star Supporter, and I would like this order to count as my one free DVD per month.
• Comments
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PLEASE NOTE: Payment is required before DVD(s) can be delivered. If you wish to have your DVD(s) delivered to you, please call customer service at 320-351-1460 to make your payment. Additional shipping charges will apply if you want your DVD(s) mailed to you.