
Please send me:
| Quantity | Title | Music (Call for price) |
Book
($15) |
Tape ($10) |
CD ($15) |
Musical Scents ($20) * | Extended Price |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
| _______ | _______________ | ________ | ________ | ________ | ________ | ______ | ____________ |
|
Postage and Handling: $4.00 for 1-2
units, $6.00 for
3-10 units Subtotal:
|
____________ |
|
Add extra $3.00 for outside USA Postage &
Handling:
|
____________ |
|
TOTAL DUE:
|
____________ |
I currently only accept Mastercard,Visa, and Discover for credit card payments.
Mastercard/Visa/Discover #: ____________________________________ Expiration Date:___/___
Name as it appears on the card: ________________________ Your signature: ____________________________________
* For Musical Scents, specify which scent you would like with
the recording you chose: _______________
(put title of recording on title line in order form)
| Please
ship the above order to: |
Your
name and address, phone # (if different from ship to): |
| Name:
___________________________________________ |
Name:
______________________________________________ |
| Street Address:
____________________________________ |
Street Address:
_______________________________________ |
| Additional Address:
________________________________ |
Additional Address:
___________________________________ |
| City:
____________________________________________ |
City:
_______________________________________________ |
| State/Country:
____________________________________ |
State/Country:
________________________________________ |
| Postal Code:
______________________________________ |
Postal Code:
_________________________________________ |
| Daytime Phone:
___________________________________ |
Daytime Phone:
______________________________________ |
| Email Address:
____________________________________ |
Email Address:
_______________________________________ |
Additional information for shipping:
_________________________________________________________________________________
Please send this form to:

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