|To order "The Silver Cord", please print this form and complete all information. Mail the completed form, along with a check or money order to the address listed below.|
|TO ORDER: Please send payment by check or money order. Each CD costs $12.00, plus shipping.
-Please add $2.50 U.S. Funds for THE FIRST CD and $1.00 for each additional CD for postage.
-If ordering from outside of the US, please include $4.50 for the first CD and $2.00 for each additional CD
-Make your money orders or checks payable to Dennis Tice.
MAIL THIS FORM AND YOUR CHECK OR MONEY ORDER TO:
503 South Juliana Street
Bedford, PA 15522
YOUR NAME ___________________________________________
CITY ________________ STATE ______ ZIP CODE ___________
PLEASE CIRCLE ONE OPTION BELOW:
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