Music Order Form

MAIL THIS FORM, ALONG WITH YOUR CHECK TO:

Duane Smith Ministries, Inc

P.O. Box 7

Randolph, Kansas 66554

MUSIC Titles

CD

Qty

Cassette

Qty

sheet music

Qty

Amount

A Perfect Heart

^$12.⁰⁰

^$10.⁰⁰

n/a

^$12.⁰⁰

n/a

^$12.⁰⁰

n/a

n/a

n/a

n/a

n/a

qSheet Music - ^$3.00 each or 2 for ^$5.00q

MUSIC Titles

No Trax Available

Sheet Music

^$3 each or

2 for ^$5

Trax

$8.00 Each

Sheet Music

^$3 each

or 2 for ^$5

MERCHANDISE TOTAL:

             SHIPPING COSTS:

$   0.00   -  $ 20.00,  add  $2.50

$ 20.01   -  $ 40.00,  add  $3.50

$ 40.01  -  $100.00,  add  $4.50

TOTAL AMOUNT OF ORDER:

Signature _________________________________________   Date: ________________

Page 2

Mailing Instructions:

1. Please type or print all information on this order form.

2. Make check out to Duane Smith Ministries, Inc.

3. Be sure that you provide all information requested.

4. If you have a P.O. Box, please be sure to include a street address as well.

SHIP TO:  

FIRST & LAST NAMES ________________________________________

ADDRESS 1__________________________________________________

ADDRESS 2__________________________________________________

CITY__________________________ STATE ________  ZIP __________

EMAIL ADDRESS ____________________________________________

Home Telephone (         )  ____  -  __________

{Please provide your phone number in case a problem arises with your order.}

"Your contact information will be kept confidential and will not be given to others."