W12849 West Lange Rd. Fairchild, WI 54741 Phone: 866-651-6472 Fax: 715-334-2014 E-mail: HYPERLINK "mailto:[email protected]" [email protected] Website: HYPERLINK "http://www.musicforgifts.com" www.musicforgifts.com

WOODSTOCK CHIMES ORDER FORM Minimum order $100.00. Call for orders over 20.

Date: FORMTEXT SHIPPING ADDRESS (if different)

Name: FORMTEXT Name: FORMTEXT

Company: FORMTEXT Company: FORMTEXT

Address: FORMTEXT Address: FORMTEXT

City: FORMTEXT State: FORMTEXT Zip: FORMTEXT City: FORMTEXT State: FORMTEXT Zip: FORMTEXT

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Have you ordered from us before? FORMCHECKBOX Yes FORMCHECKBOX No Chime Selection: Select your Windchime

Name: FORMTEXT Qty: FORMTEXT X $ FORMTEXT = $ FORMTEXT Name: FORMTEXT Qty: FORMTEXT X $ FORMTEXT = $ FORMTEXT

Name: FORMTEXT Qty: FORMTEXT X $ FORMTEXT = $ FORMTEXT

Name: FORMTEXT Qty: FORMTEXT X $ FORMTEXT = $ FORMTEXT

SubTotal: ...... $ FORMTEXT Sales Tax: (WI only) SubTotal $ FORMTEXT X 5.5% = $ FORMTEXT Shipping: First Chimes: ($4.50) $ 4.50 Each additional chime $1.00 each Additional Qty (over 1): FORMTEXT x $1 $ FORMTEXT Residential Shipping: ($3.00 charge) $3.00 : $ FORMTEXT

Total: ...... $ FORMTEXT PAYMENT METHODS: VISA FORMCHECKBOX , MASTERCARD FORMCHECKBOX , AMERICAN EXPRESS FORMCHECKBOX , or CHECK FORMCHECKBOX (check one) Credit Card #: FORMTEXT Exp: FORMTEXT or Check #: FORMTEXT