PRINT THIS FORM FROM YOUR BROWSER AND MAIL WITH CHECK OR MONEY ORDER MAKE CHECK OR MONEY ORDER PAYABLE TO GARY DuBOSE

SGHS BAND CD ORDER FORM

	MAIL YOUR ORDER TO:	Gary DuBose 3301 So. Glenbrook Dr. Garland, TX 75041-4406

	ITEM	QTY	PRICE	COST
	BAND CD 1971		$ 20.00 ea.
	BAND CD 1972		$ 20.00 ea.
			TOTAL =

	YOUR ADDRESS:	NAME:                                                               ADDRESS:                                                         ADDRESS:                                                         CITY:                                                                 STATE:                                                               ZIP:

YOUR EMAIL ADDRESS IF YOU WANT TO BE NOTIFIED OF RECEIPT OF YOUR ORDER

SHIPPING WITHIN THE USA IS INCLUDED IN THE UNIT PRICE MAKE CHECK OR MONEY ORDER PAYABLE TO GARY DuBOSE PLEASE ALLOW FOUR WEEKS FOR DELIVERY