Please print this form and mail to:

     Mike Curtis
     199 Augusta Plantation Dr. Unit H
     Myrtle Beach, SC 29579

Checks and Money Orders - Make payable to Mike Curtis

     Place an X in the box next to the video(s) you wish to purchase

Steppin' It Up With All That!

  $95 - Steppin' It Up With All That!
1 Video, 4 Teachers, 20 steps

Ship To:

Name
____________________________________

Address
____________________________________

City
____________________________________

State ______   Zip ___________

Phone ______________________________

E-mail ______________________________



_____  Video Subtotal


    +    $5   Flat Rate Shipping


_____  Total Amount Enclosed