Please
print out this form, fill it out with a black pen & mail or fax with credit card information to us.
Mail money order and form to: Midi Mark Sales, PO Box 217, Whittier, CA 90608, U.S.A.
or Fax it to: 562-365-1298 - Back to home page
Please
print out this form,
fill it out with a black pen & mail or
fax with credit card information to us.
Mail money order and form
to: Midi Mark Sales, PO Box 217, Whittier, CA 90608, U.S.A.
or
Fax it to: 562-365-1298 - Back
to home page
NAME __________________________________________ COMPANY NAME (optional)
EMAIL ADDRESS _______________________________ - ________________________
ADDRESS ____________________________________ APT _______
CITY _______________________ STATE _____ ZIP _____________
PHONE ( _____ ) ___________________ FAX ( _____ ) ____________________
SAMPLER MAKE ___________ MODEL _____________
DISK NUMBERS .......................................PRICE
01__________ 11___________ 21___________ - _________
02__________ 12___________ 22___________ - _________
03__________ 13___________ 23___________ - _________
04__________ 14___________ 24___________ - _________
05__________ 15___________ 25___________ - _________
06__________ 16___________ 26___________ - _________
07__________ 17___________ 27___________ - _________
08__________ 18___________ 28___________ - _________
09__________ 19___________ 29___________ - _________
10__________ 20___________ 30___________ - _________
OTHER
________________________________ - _________
OTHER
________________________________ - _________
SUB TOTAL------------------------------------------ $ _________
CALIFORNIA RESIDENTS ADD 8.25% TAX .$ _________
SHIPPING &
HANDLING MINIMUM $4.50 . $ _________
FOREIGN ORDERS ADD $10.00
SHIPPING . $ _________
TOTAL -------------------------------------------------$ _________
IF YOU WOULD LIKE TO PAY BY MONEY ORDER, MAIL
THIS FORM AND MONEY ORDER TO US.
NAME ON CARD ___________________________ SIGNATURE _____________________________
CARD NUMBER _______________________________ EXP DATE _____
©1997-9 & 2005 Midi Mark Enterprises. (credit card orders only shipped to verified card billing address)