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.