Print a GOREGIASTIC RECORDS Order Form

GOREGIASTIC RECORDS Mail Order Form
- - - - - - - - - - - - - - - - - - - -
CHECKS & MOs PAYABLE TO: CARLOS A. GARCIA ONLY!.

Please send to:
Goregiastic Records
PO Box 800178
Elmhurst, NY 11380 USA
- - - - - - - - - - - - - - - - - - - -
Please review our ORDERING INFORMATION at www.goregiasticrecords.com (ONLINE SHOP section) before sending your order. We accept checks and money orders payable to CARLOS A. GARCIA. You may send well-hidden cash, but be aware that we are not responsible for cash that is stolen or lost in the mail.
--------------------------------------------------------------
To order, please fill out this order form - PRINT CLEARLY:

Email address:__________________________
Your Name: _____________________________________
SHIPPING ADDRESS: _______________________________ Apt/Suite #: _____________
City: ________________ State: ____ Zip(or Postal Code): __________ Country: _________________

Phone number (IMPORTANT): __________________________
Please List the Items You Would Like To Order:
Item 1 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 2 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 3 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 4 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 5 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 6 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 7 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______
Item 8 _________________________FORMAT ____ QTY ____ Unit Price ______ Price ______

FREE SELECTION(S) - (If applicable):

FREE 1 ______________________________ FORMAT ______
FREE 2 ______________________________ FORMAT ______
FREE 3 ______________________________ FORMAT ______
FREE 4 ______________________________ FORMAT ______

Please list several alternate selections (VERY IMPORTANT):

ALT 1 ______________________________ FORMAT ______ Price __________
ALT 2 ______________________________ FORMAT ______ Price __________
ALT 3 ______________________________ FORMAT ______ Price __________
ALT 4 ______________________________ FORMAT ______ Price __________

Sub-total __________________

IMPORTANT: Please review our ORDERING INFORMATION at www.goregiasticrecords.com (ONLINE SHOP section) to determine your shipping costs if you are an international customer (shipping within USA & Canada are FREE!).

Shipping charges (only for internat. orders): $____________
New York residents add $8.625 sales tax: $____________
TOTAL FOR YOUR ORDER $_____________

Payment Method (check one): ( ) Check ( ) Money Order ( ) Cash ( ). If paying by credit card - CREDIT CARD Type (choose): ( ) MasterCard ( ) Visa ( ) American Express ( ) Discover

Card No: ___________________________ Expiration Date (mm/yr): ____/____
Name Appearing on Card (print clearly): __________________________

By SUBMITTING this order form to Goregiastic Records, you hereby state that the above credit card information is correct and that you are the valid credit card holder.

Signature (REQUIRED for credit card orders ONLY):