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ORDER FORM

BELL MOUNTAIN MUSIC 

 NAME_______________________________________________

 ADDRESS_______________________________________________   

 CITY______________________________ST______ ZIP______________

 PHONE____________________________e-mail____________________  

ITEM #

DESCRIPTION

#

PRICE
       
       
       
       
       
       
       
       
       
       
       
       
       

 PAYMENT METHOD (CHECK ONE)

 _____ CHECK, MONEY ORDER, CASHIERS     
 _____ VISA
 _____ MASTERCARD
 _____ DISCOVER
_____  AMERICAN EXPRESS

 CARD #__________________________________
 EX DATE ______  3 Digit Security Code_____       On back of Card after Credit Card Number

 SIGNATURE_______________________________
  e-mail:  bellmtnmusic1@alltel.net
 MAIL TO:
 BELL MOUNTAIN MUSIC
 8662 Oakview Road
 Melrose, FL 32666

 PHONE: (800) 833-1973

TOTAL ____________

        FLORIDA RESIDENTS

6% SALES TAX ____________


 ( S & H PER ORDER)
 US: $3.95 Media Mail; $6.25 Priority Mail
 Canada: $5.25  

____________

TOTAL ORDER ____________

INTERNATIONAL ORDERS: ACTUAL SHIPPING COSTS - CONTACT FOR TOTAL S&H
CANADIAN ORDERS: POSTAL MONEY ORDER
IN US DOLLARS OR VISA/MASTERCARD/DISCOVER/AMERICAN EXPRESS 

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