Print and use this form to order by Mail

Please Write Neatly

QUANTITY       __      ITEM/TITLE    __               PRICE__        TOTAL

Subtotal                               ____________________

CT residents add 6% sales tax   ____________________

Postage:*(US/Can) $3.50 first item,

$1 each additional item           _____________________

*Foreign postage: $5.00 first item,

$1.50 each additional item       _____________________

Grand   Total                        _____________________

Please send check or money order (US funds) to:

Phunquie Pholk Music,

PO Box 290752

Wethersfield, CT 06129-0752

Your Shipping Address:

Name:

Street (Apt. #) or P. O. Box: