ROCKANDROLLETC.COM ORDER FORM

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PLEASE PRINT THIS OUT & SUBMIT WITH YOUR PAYMENT, or
SUBMIT BY EMAIL AFTER FILLING OUT THE SHIP TO: SECTION AT THE BOTTOM

WE MUST RECEIVE AND CONFIRM PAYMENT BEFORE SHIPPING ORDERS.
WE ACCEPT VISA, Mastercard, American Express, Check, or Money Orders in US FUNDS ONLY.
Make checks & money orders payable to:
C&L DISTRIBUTORS
PO Box 454
East Longmeadow, MA
01028 USA
phone: 413 747 3901

ITEM - DESCRIPTION QUANTITY PRICE
$
$
$
$
$
$
$
$
$
INSURANCE $1.60
ADD POSTAGE (US) $4.50
POSTAGE (Overseas) $14.00
TOTAL WITH POSTAGE - $

SHIP TO:
*Card
*Name on Card
 First __MI __Last
*Number
*Exp
*Name:
*Email Address:
*Street Address:
*City:
*State:
*Zip:

 

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To send funds via PayPal please use our email address: autumnsong@rcn.com