Bushwick Homecomings DVD Order Form
(Please Print this Form)

PURCHASED BY:	SHIP TO: (if different from purchaser's name and address):
Name________________________________________	Name________________________________________
Address________________________________________	Address________________________________________
City________________________________________	City________________________________________
State________________________________________	State________________________________________
Zip________________________________________	Zip________________________________________
Email Address________________________________________
_______Cashier's/bank check or money order included (no personal checks)

Make checks payable to and mail form and/or purchase requisitions to: Msjosh Productions, LLC P.O. Box 1583 New York, NY 10159

Please print and circle one entry that applies to your order

(Note: Orders ship via Priority Mail Flat Rate with delivery confirmation, Domestic orders only, please email inquiries for international shipping rates.) Purchase requisitions/orders may be calculated using table below and sent via mail or emailed to info@bushwickhomecomings.com.

Item	Price	Shipping	Grand Total
1 Bushwick Homecomings (DVD only)	$24.99	$5.65	$30.64
1 Bushwick Homecomings DVD w/ *Public Performance Rights for Purchaser/College	$174.99	$5.65	$180.64

*Public Performance Rights entitles purchaser (educator or organization) to utilize the proprietary material in classroom presentations, curriculum, library use, college film festivals and closed circuit TV broadcast for educational institutions.

Questions? Contact: info@bushwickhomecomings.com

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