Black Swan Merchandise Order Form
| Contact and Shipping Information | |||||
|---|---|---|---|---|---|
| Your Name: | Order Date: | ||||
| Address: | |||||
| City, State, ZIP: | |||||
| Country: | Telephone: | ||||
| Card Type | Circle one: |
Visa |
MasterCard |
AMEX |
Discover |
| Card Number | Expiration | ||||
| Name on Card | |||||
Signature |
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| RECORDING | TYPE | QUANTITY |
PRICE EACH | TOTAL PRICE |
|---|---|---|---|---|
| Dance Hall Favorites (2010) NEW | 2 CDs | $26.00 | ||
| Feel the Spirit (2007) | CD | $16.00 |
||
| This Joint is Jumpin' (2005) | CD | $16.00 |
||
| Ragtime Revelry (2003) | CD | $16.00 | ||
| Mama's Gone Goodbye (2001) | CD | $16.00 | ||
| A Joyful Noise - Jazz Gospel (2000) | CD | $16.00 | ||
| ARRANGEMENTS
($12) or COLLECTIONS ($99.99) |
QUANTITY | PRICE
EACH |
TOTAL PRICE |
|
| 1. Title: | $ | |||
| 2. Title: | $ | |||
| 3. Title: | $ | |||
| 4. Title: | $ | |||
| 5. Title: | $ | |||
OTHER ITEMS
NEW |
SIZE |
QUANTITY |
PRICE EACH | TOTAL PRICE |
| Black and Gold Logo Shirt (Polo) | $30.00 | |||
| Shipping and Handling (Shipping included for USA orders - $5 additional postage for international orders) | ||||
| TOTAL PURCHASE | ||||
| Please
send this completed form along with your check, money order or completed
credit card information to: |
|
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