ORDER FORM

Print this form and mail it in, or e-mail your order.
Send postage paid US$ money order or check drawn on US Bank to:

HC3 MUSIC
PO BOX 30855
ALEXANDRIA, VA  22310     USA

qty

ITEM

CAT. #

$/unit

Total

   

cs

CD

cs

CD

 
First Transmission NMCa3 $ 7.00 na
The Sleeper Dislodged NMCd2 $12.00
A Broken Mold NMCd1 $12.00
Surge Zone NMCd4 $12.00
The Lost Signal NMCd5 $12.00
Staalhertz NMCd6 $12.00
Dark To Dark / Dark Too NMCd7/8 $12.00 per set
TL0741: Back to Minus
coming July 2008
TLCd1 $12.00
Merchandise Subtotal * * Price includes shipping & handling * *
Sales Tax VA RESIDENTS ADD 4.5%
TOTAL ENCLOSED $

 

 SHIP TO

___________________________________________________________

ADDRESS ___________________________________________________________
___________________________________________________________
CITY ___________________________________________________________
STATE ______________________________   ZIP ________________________
COUNTRY ___________________________________________________________
e-mail ___________________________________________________________
website ___________________________________________________________
comments ___________________________________________________________
___________________________________________________________
___________________________________________________________