Mail Order and Fax Form
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Customer ID: _______________________

Name: ______________________________

Daytime Phone/Fax: _________________

Shipping Address: ___________________

____________________________________

____________________________________

____________________________________

Email Address: _____________________

Date: __________________

Notes:

ORDER INFORMATION
 Item  Price  Artist    Item  Price  Artist
             
             
             
             
             
             
             
             
             
             

Shipping Instructions: ______________

Payment Information: _______________

Credit Card: _______________________

Account Number: __________________

Expiration Date: ___________________

A CLASSICAL RECORD
547 W. 27th St., Suite 680
New York, NY 10001
Voice: 212-675-8010
Fax: 212-971-0151
Email: Aclassrec@aol.com

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