Jazz Record Center Order Form

Jazz Record Center Order Form
Mail this Order Form to:		Home	All information will be kept confidential and used only for your order.
	Jazz Record Center 236 West 26th St Room 804 New York, NY 10001 USA - or - FAX to: 212.675.4504

Please print out this order form to mail in your order.

Your Name______________________________________________

Street______________________________________________________

City__________________________ State________ Zip code__________

Country_____________________________________________________

Daytime Telephone Number_____________________________________

Items_______________________________________________________

___________________________________________________________

Method of Payment:
    [ ] check enclosed   (Make check payable to Jazz Record Center.)
    [ ] Credit Card     Check one:          [ ] Visa         [ ] MasterCard         [ ] Discover

         Card number: _____________________________ Exp. date: Mo______ Yr______

         Signature:_________________________________________________________
                          (Required on all charge orders. Sign just as you would sign your credit card.)

Thank you!