Wallace Coleman CDs and Poster
Merchandise Order Form

Print, Complete & Mail This Form With your Check/Money Order made payable to: 

Wallace Coleman
18019 Larchwood Avenue (Front)
Cleveland, OH  44135

Name:______________________________________________________________
Address:____________________________________________________________
City:______________________________       State: ________       Zip:__________
Phone (optional): _____________________________________
E-Mail Address (optional): ______________________________
CDs

  ______each  "Repossession Blues" 

 ______ TOTAL NUMBER  of CDs ordered x $22..00 = $ __________


 
  ______each  "Stretch My Money"
  ______each  "Live At Joe's"
  ______each  "The Bad Weather Blues"

 ______ TOTAL NUMBER  of CDs ordered x $15.00 = $ __________


                                                    TOTAL CDs  = $ __________
                                                                                                                                                                                      

POSTER
   ______each  Wallace Coleman Signed Poster (11" x 17")

  ______ TOTAL NUMBER of posters orders x $5.00 = $ __________

Shipping included in pricing for Continental US orders only
International shipping rates appear below
 

_______   SUBTOTAL (TOTALS FROM ABOVE)
_______   OHIO RESIDENTS ONLY  add 8% tax   (per CD=$1.20)   ( per Poster = .40)

_______   TOTAL ENCLOSED

 International Shipping Rates - 1 item= 4.00     2 items=5.50
                                               3 items=7.50    4 items=9.50  5+ items-contact us

Thank you for your order!
  

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