APIRNALA RECORDS & MUSIC ORDER FORM

APIRNALA

Records & Music

Order Form

Apirnala Records & Music utilizes a Secured Server to ensure that your credit card numbers are kept confidential and encrypted before they are sent over the Internet, safe from prying eyes and potential thieves.

*(Note: If ordering from outside the United States, please include country code, city code, and number in the phone number blank.)*
Name (As Shown On Credit Card)
Address (Billing Address)
Address (Continued)
City
State or Province
Zip Code:
Country
Phone:

Fax:

Email:

Enter the quantity of each item you want below.
*All prices in US Dollars.*
Quantity	Product	Price
	Back To Romance CD	$9.95
	Back To Romance Cassette	$5.95
	Back To Romance Poster	$4.95
	Modern Woman Renaissance Man CD	$9.95
	Modern Woman Renaissance Man Cassette	$5.95
	Modern Woman Renaissance Man Poster	$4.95
	Highway 88 CD (only)	$9.95
	Highway 88 Poster	$4.95

Shipping Charges:
US Locations--$1.95 for first item and $1.00 for each additional item.
Non US Locations--$3.95 for first item and $1.00 for each additional item.

Calculated Costs
Extended Cost: $
Total Tax: $
Total Shipping: $
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Total Charges: $