Big Band Jump

ONLINE ORDER FORM

You can fax to 404 231 7990
or to order by phone,
call toll-free 1-800-377-0022.
If we're not available at the moment you call, please leave a message and we WILL call you back.

Please provide the following contact information:

Name

Work Phone

Home Phone

E-mail

Please provide the following ordering information:

QTY ITEM NUMBER OR DESCRIPTION PRICE EACH

$

$

$
$

$

$

$

$

$

$

Merchandise Total    $

IF ordering two items: Less 10% *

OR IF ordering three or more items: Less 15% * $

* This discount may NOT be combined with any other discount.

Merchandise Total    $

Total Shipping Due:   If free enter a zero.   $

International Shipping add US $10.00 $

Total Amount Due: US $

BILLING

Credit Card

Cardholder Name

Card Number

Expiration Date

SHIPPING

INTERNATIONAL ORDERS:
Orders from outside the United States are subject to an additional $10.00 (U.S.) mailing charge.

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

You may wish to print this page before submitting.
You will receive a confirmation e-mail,
but that e-mail comes from a real person
that does not work 24/7, so it may be a little while before you get it.

To order by phone, call toll-free 1-800-377-0022.
If we're not available at the moment you call, please leave a message and we WILL call you back.

QTY	ITEM NUMBER OR DESCRIPTION	PRICE EACH
		$
		$
		$
		$
		$
		$
		$
		$
		$
		$
	Merchandise Total	$
	IF ordering two items: Less 10% *
	OR IF ordering three or more items: Less 15% *	$
* This discount may NOT be combined with any other discount.
	Merchandise Total	$
	Total Shipping Due: If free enter a zero.	$
	International Shipping add US $10.00	$
	Total Amount Due: US	$

	BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

	SHIPPING
INTERNATIONAL ORDERS: Orders from outside the United States are subject to an additional $10.00 (U.S.) mailing charge.
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Copyright © 2000 Big Band Jump. All rights reserved.