Name ____________________________________________________________
Address __________________________________________________________
City __________________________________ State _______ Zip ________
Country _____________ E-Mail Address ______________________________
Phone (________) __________-____________________
Ordering Info
|
Title
|
Circle Cost
|
Circle
Quantity
|
$ Amount
|
|
Randall Gilbert's "Mirage" CD
|
$12.99 CD
|
1 2 3 4 5
6 7 8 9 10
|
|
|
Mirage T-Shirt
|
$11.50
T-shirt
|
1 2 3 4 5
6 7 8 9 10
|
|
| List T-Shirt sizes and quantity: Small______, Meduim_______, Large_______, Xtra Large_______ |
|
Sub Total:
|
$ |
|
Add 5% state sales tax - (In Virginia only )
|
$ |
|
S&H $2.50 per item (up to $7.50 max.)
|
$ |
|
Total (USD):
|
$ |
|
Print and fill out this page, then mail it to:
Randall Gilbert • 1016 Windsor Ave. • Roanoke VA 24015
(Be sure to include your check, monor money order and return address.)
Payment: Check/Money order (U.S. funds only) payable to Randall Gilbert
Please allow 2-6 weeks for delivery. All prices U.S. Dollars and subject to change.
E-Mail: info@randallgilbert.com