Order Form

Thank you for choosing Lucerne!
For fastest service, print out Order Form, then fill in and fax to us.

Sales Office
Lucerne Media
720 Pinehurst Lane, Buffalo Grove, IL 60089
Tel.: Toll Free 1-866-537-0009
Fax: 847-537-0050

Headquarters Office
Lucerne Media
37 Ground Pine Rd., Morris Plains, NJ 07950
Tel.: Toll Free 1-800-341-2293
Fax: 973-538-0855

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Program:	Price:

Name:
Position:
Institution:
Street Address:
City:
State:
ZIP:
Telephone Number:
Fax Number:
E-Mail:
Signature:
PO#
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Orders are shipped UPS. A Shipping & Handling fee is added to your invoice. S&H: 7% (minimum $6).
Public Performance Rights are included in the purchase price.
Television/Cable and Duplication Rights are not included and must be obtained from Lucerne Media.
All Lucerne Media programs are protected by the copyright law and may not be reproduced in any form without written permission from Lucerne Media.