Contact Name___________________________ BandName_____________________________

CD/Cassette Title_______________________________________________________

Shipping Address: (No PO Boxes)_____________________________________________________

City, State, Zip____________________________________________________________________

Contact Phone Number with Area Code_________________________________________________

Email address___________________________________

CDs Ordered ____500 ____1000 _____Other__________

CD Inserts (circle one) 2-panel 4-panel 6-panel Other___________________________________

Cassettes Ordered ____300 ____500 ____1000 ____Other_________

Cassette Inserts _____standard (1 page/2panel) or ______# of Extra Panels

Do you need design services? Yes No

Do you need film output? Yes No

Please mark all enclosed items:

  ____CDR ___DAT ____Zip, CD-ROM, or Syquest with design ____Print Film

Total Amount Enclosed:_________________(minimum 75% of total)

Special Instructions:

Please fill out form fully or your order will be delayed. Ship your materials via UPS, FedEx, or another company that can track your package to: Bill Heydolph * 31 Central Square, Suite 2 * Keene, NH, 03431 . (888) 949-6999