| Ordered by: | Ship to (if different): |
| Name: | Name: |
| Address: | Address: |
| Address: | Address: |
| City, State, Zip: | City, State, Zip: |
| Country, Province: | Country, Province: |
| Phone: | E-mail: |
| If paying by credit card, please be sure that your name and address are exactly the same as your credit card billing statement. | |
| Quantity | Description | Price Each | Total |
| Steve Evans' "Be There" CD | $15.00 | ||
| Shipping & Handling (see below) | |||
| WI
Sales Tax 5% (Wisconsin Residents Only) |
|||
| TOTAL | |||
| Method of Payment | ||||
|---|---|---|---|---|
| Check _____ | Bank Check _____ | Money Order ____ | VISA ____ | MasterCard ___ |
| Card Number |
3-digit CVC # (back of card) __ __ __
Exp. Date __ __ - __ __
Signature(for credit card): ___________________________________________
$2.00 for 1-3 items $.30 each additional item | $3.00 for 1-3 items $.40 each additional item | $5.00 for 1-3 items $.50 each additional item |