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Brelmat Music/CDs and Sheet Music Order Form


First Name:____________________________ Last Name: ______________________________________________


Company or Institution: __________________________________________ Position: ________________________


Mailing address:_________________________________________________________________________________


City:__________________________________ State: _______ Zip: ________-_____ Country: __________________


Phone ( ____-____-_____ ) Fax ( ____-____-_____ ) E-mail address: __________________@__________________


If paid by credit card circle: Master Card - Visa - American Express - Discover


Credit card number: ______-______-_____-_____ Card Expiration Date:____/____

May we include you on our confidential mailing list? Yes - No


Quantity
Item #

Item Description
Item Price
Total Price







 







 







THANK YOU FOR YOUR ORDER !







Subtotal
Postage
PA Sales Tax / 6%
Grand Total

 











 
How to order music/CDs from Brelmat Music
You may order in four ways:
1. telephone 610-756-6324
2. fax 610-683-4694
3. e-mail brelmat@verizon.net- type information requested on form in your letter
4. regular mail Brelmat Music, 241 Kohler’s Hill Rd., Kutztown, PA 19530-9181
You may pay with any of three methods:
1. Credit card (Master Card, Visa, American Express, Discover)
2. Personal or business check (U.S. currency/U.S. bank)
3. Money order (U.S. Currency)
Shipment will be made by priority mail in USA or by Air Mail oversees unless arranged for otherwise. All shipments must be pre-paid.Additional costs: Add $2.00 for USA orders up to $20.00; $4.00 for USA orders $20.01 and above. In cases of heavy packages and long distances, Brelmat reserves the right to charge the customer the actual postal rate as determined by U.S. Postal Services.
For international orders add $4.00 for orders up to $20.00 and $6.00 for orders $20.01 and above.
Pennsylvania residents add 6% sales tax.