2112 Percussion Order Form

BILL TO:

Name ________________________________
Address ______________________________
City/State/Zip _________________________

Phone & Fax __________________________

SHIP TO: (if different)

Name: _______________________________
Address: _____________________________
City/State/Zip: ________________________

CREDIT CARD INFO:

Circle type: Mastercard - Visa - American Express - Discover

Account # ______-______-______-______ Exp. _______

Signature ______________________________

QUAN	PART#	DESCRIPTION	PRICE	TOTAL
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Subtotal - ____________

Shipping - ____________

7% Sales Tax (NC residents only) - ____________

Total Due - ____________

SHIPPING AND HANDLING CHARGE (Continental US Only)

Under $200 Purchase ($7.50 for east coast, $10 for central and west coast)
$200 or More Purchase FREE SHIPPING