First and last name (Nombre y apellido): ____________________________

Address (Dirección postal): _______________________________________

City (Ciudad): __________________________________________________

State and Zip Code (Provincia y codigo postal): _______________________

Country (País): __________________________________________________

Email: _________________________________________________________

Telephone (Teléfono): ____________________________________________

Name of CD (Nombre del CD): ____________________________________

                                             ____________________________________

                                             ____________________________________

CD: $15.00                               ____________________________________

Shipping $2.00 each (Precio de envío $2.00 por copia): _________________

Total:                                                                          ______________


Please send form and check to the following address:
(Enviar formulario y cheque a la suiguiente dirección):

Emiliano Pardo-Tristán
1915 Green St. Apt. 2
Philadelphia, PA 19130
USA