Pianolight Music - fax order form

PIANOLIGHT ORDER FORM

*Please Make Sure you specify quantity in the appropriate field(s)

First Name: Last:

E-mail:

Address:

City:

State: Zip Code:

Phone

Work #

Country

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SHIPPING AND HANDLING:

$2.95 for first item ordered

$1.00 per each additional item

CALIFORNIA RESIDENTS add 8.25% sales tax

SUB TOTAL

Shipping and Handling

Calif. Res. add 8.25%Tax

total number of pieces
Total

Method of Payment

Name as it appears on Credit Card:

Credit Card #:

Expiration Month: Year:

PLEASE CALL (800)487-8659 TO ORDER

OR

PRINT OUT ORDER AND

FAX TO (818)765-0617

OR

MAIL TO: PIANOLIGHT MUSIC, INC.

12400 VENTURA BLVD.SUITE 341

STUDIO CITY, CA 91604

ALL ORDERS MUST BE PAID EITHER BY

MASTERCARD OR VISA,

OR TO BE PREPAID BY CHECK

THANK YOU!

	PIANOLIGHT ORDER FORM *Please Make Sure you specify quantity in the appropriate field(s)
First Name:	Last:
E-mail:
Address:
City:
State:	Zip Code:
Phone Work #
Country