ORDER GUIDE FOR 6-DIGIT PART NUMBER: KellyMouthpieces.com MOUTHPIECE PART NUMBERS: Ex: TP3CPK = Trumpet, 3C, Punk Pink ORDER FORM e-mail: [email protected] First 2-digits: MOUTHPIECE TYPE DATE: CO Cornet 6-digit PART NUMBER QUANTITY UNIT PRICE PRICE TP Trumpet FH French Horn MP Mellophone FL Flugelhorn Company: TB Smalll-shank Trombone / Baritone EU European Shank Euphonium BB Large-shank Trombone / Euphonium Contact: TU Tuba - American Shank TS Tuba - Small Shank Address: Second 2-digits: CUP SIZE KS KELLY Screamer 7C Cornet / Trumpet 7C City: State: 5C Trumpet 5C 3C Cornet / Trumpet 3C 15 Trumpet 1 1/2C Zip Code: _________________________ Country: ____________________________ 65 Trombone-Small Shank 6 1/2AL 12 Trombone-Small Shank 12C Phone: Fax: 51 Trombone-Small Shank 51D 5G Euphonium-European Shank 5G 51 Euphonium-European Shank 51D Email: 5G Trombone-Large Shank 5G 15 Trombone-Large Shank 1 1/2G 51 Trombone-Large Shank 51D KE Tuba KELLYberg 24 Tuba 24AW 18 Tuba 18 Paid by: C.O.D. CHECK # PO# www.PayPal.com 25 Tuba 25 XS Tuba X-SMALL MASTERCARD / VISA / DISCOVER / AMERICAN EXPRESS MC French Horn Medium Cup DC French Horn Deep Cup Card # 6V Mellophone/Flugelhorn 6V Exp Date Sec Code Third 2-digits: COLOR Cardholder Name CR Crystal Red RH Red Hot Billing Address & Zip PK Punk Pink CO Crystal Orange Signature MY Mellow Yellow HG Harvest Gold RG Radical Green CG Crystal Green BL True Blue Shipping & Handling Prices: CB Crystal Blue Total Price of Order USA Canada International CP Crystal Purple Up to $78 $7 $15 $21 MM Marching Maroon From $79-$195 $12 $22 $41 SUBTOTAL GD Glow-in-the-Dark From $196-$500 $27 $31 $59 WW White Wedding $501 & Above $31 $46 $83 S&H JB Jet Black CC Crystal Clear WI 5.5% SG Steel Grey Sales Tax TOTAL KELLY Mouthpieces, 674 South Pioneer Road, Fond du Lac, WI 54935 Fx 920-922-7308 [email protected] www.KellyMouthpieces.com L:\Data\SSC_OrderForm.xlsx.