Mail or Fax in your order
Print out the following order form and either:

  1. Fax it to (866-821-8323) Credit Cards Only
  2. Snail mail it to (Checks, Money Orders or Credit Cards):
    Media Works
    PO Box 485
    Yorktown Heights NY 10598

Yes, rush me Break Dancing Made Simple, Vol. 1. I understand that if after using all the techniques and strategies in the video I am not completely satisfied within 1 year, I can return it for an immediate refund... no questions asked. The video will be sent USPS Priority 1-2 Day Service within 24 hours of receiving your order and is guaranteed to arrive within 5 business days.

Name: _________________________

Email: _________________________

Company (optional): _________________________

Address: _________________________

City: _________________________

State: _________

Country: _________________________
(please check your shipping costs below)

Zip: _________

Phone: (___) ____ - ______

(  ) I am enclosing a check or money order for $19.95 USD plus $3.85 s/h (*$5.00 flat rate for international orders*) payable to "Embroidwear" --Please note that we do not accept checks by fax, so if you are paying by check you must mail it in.

(  ) I want to charge $19.95 plus $3.85 s/h (*$5.00 flat rate for international orders*) to my Credit Card Note: All overseas orders are shipped by USPS Global Priority Mail

Credit Card (check one):
American Express
Discover Card Number: _________________________

Expiry Date: _________

Signature: _________________________

I authorize Embroidwear to charge $19.95 plus my applicable shipping to my credit card for the purchase (and shipment) of the Break Dancing Made Simple Vol. 1 Video.