Please print the following form from your browser then fax it to
Al White (870) 534-5916
Visa and MasterCard only.
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Name: .......................................................................
Company: ...................................................................
Shipping Address: .........................................................
City: ....................................... State: .... Zip: ...............
Phone #: ............................ Fax #:................................
Billing Address: ............................................................
City: ....................................... State: ...... Zip: ............
Credit Card #: ..............................................................
Exp. Date: .............. Name of Cardholder: ..........................
Signature: ..................................................................
I want an autographed copy of Jazz Party. My custom message
is in the following box:
Jazzparty -- $50.00 + $5.00 S/H
Total Due: $55.00
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