| Product ID | Title | Unit Price | Quantity | Price |
| 5110 | Apple TV | $149.00 | _____ | $_________ |
| 4703-USB | Belkin 5-Outlets Mini Surge Suppressors with USB Charger (Needs 6) | $22.50 | _____ | $_________ |
| 4011 | Computer Microscope USB (Needs 5) | $69.95 | _____ | $_________ |
| E1913 | Dell 19" Flat Panel Monitor | $129.00 | _____ | $_________ |
| P2213 | Dell Professional 22" Widescreen Monitor (Needs 5) | $199.00 | _____ | $_________ |
| GPH5-B | GoPro HERO8 Black Activity Camera | $299.99 | _____ | $_________ |
| HXVR1 | HygenX Vray High Intensity Portable UV-C Sanitizer - Kills 99.9% of Bacteria (Needs 2) | $230.00 | _____ | $_________ |
| MB-2016X1 | Donated 4G LTE hotspots with Mobile Beacon's Unlimited Internet Service (Needs 11) | $0.00 | _____ | $_________ |
| Cash Donation (Any Amount) | ||||
| Shipping (8%): | $_________ | |||
| Tax (5%, Vermont Only): | $_________ | |||
| Total: | $_________ | |||
Credit Card (circle one) Visa Mastercard Amex Discover
Credit Card #: ____________________________________
Expiration Date:____/_____ CVV2* Code:______________
Exact Name on Card: ______________________________
Phone: ______________________________
E-mail Address: ______________________________
Credit Card Billing Address:
______________________________________________
______________________________________________
______________________________________________
Please make all checks payable to "Digital Wish". Please return payment along with this form to the appropriate teacher. Or mail with payment to:
Digital Wish
PO Box 255
Milton, DE 19968
For more information on these products, or to purchase online, visit http://www.digitalwish.org, or call (866) 344-7758.