Changing Lives Special Purchase Order Form - California Select Privilege Group: Money Orders Only A B D (PSU) D (HSU) Inmate Information: (Please print clearly) Inmate’s Full Name Inmate’s CDRC # Institution Name Dorm / House Institution Address City Male Female State Zip Code State Zip Code Customer Information: (Please print clearly) Your Full Name Your Email Address Your Address City Your Phone Number Qty. Item Weight JPay eReader Package includes a Protective Cover, a set of KOSS® Lightweight Earbuds, a Micro-USB B Cord, a USB Charging Adapter Price Subtotal Totals No back orders or substitutions allowed. 298g (10.6oz) $59.99* Subtotal $ Sales Tax $ S&H $ 5.90 Total $ *Price does not include sales tax or shipping & handling. Price is valid for 12 months from January 1, 2015 and expires on December 31, 2015. Total Weight Subtotal Make money order payable to JPay. Send to PO Box 279217, Miramar, FL 33027 Customer Service is available 24/7/365. Call 800-574-5729 or email [email protected] California Department of Corrections and Rehabilitation The California Department of Corrections and Rehabilitation (CDCR) has approved this independent vendor to sell merchandise to inmates and the public. CDCR's brief review and approval of this vendor was strictly limited to minimum security requirements and generalbusiness intent. The CDCR is not affiliated with this vendor and does not guarantee that the vendor will fulfill any obligations, perform as expected, nor permanently remain in business, nor does the CDCR guarantee the vendor's products in any way. Any purchases fromthis vendor are at the buyer’s sole risk. The CDCR assumes no liability whatsoever for such purchases, nor any aspect thereof. Any issues or disputes regarding the vendor's products are the sole responsibility of the buyer and/or the vendor, and the CDCR is not obligated to mediate or resolve any such disputes.
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