PLEASE PRINT OUT PAGE & FAX OR MAIL TO ADDRESS BELOW:

ORDER FORM

NAME: _______________________________________________

ADDRESS: ___________________________________________

CITY ________________________________ STATE __________

ZIP CODE: _____________________________

WORK PHONE: ______________________________

SCHOOL WORK PHONE: ______________________

HOME PHONE: ________________________________

FOR: RENE GONZALEZ "THE HUMMINGBIRD"
Holiday Special Price $15.00
(SHIPPING & HANDLING-Regular Ground) $6.95
(For 2-Day Shipping add $10.00)

TOTAL AMOUNT DUE: $21.95

Please make remittance (check, Purchase Order or Money Order) payable to:

ELLIS FAMILY MUSIC CO., INC.

and send to:

ELLIS FAMILY MUSIC CO, INC.
30 SAMANA DRIVE
MIAMI, FL. 33133

Please allow 2-4 weeks for Regular delivery. Thank you.