FAX Order Form (IN1)
Billing and Shipping Information

Your Name: _______________________ Ship Via*: ______________
Account Number: ________________ Back-Order: ___Yes ___No

*All orders are usually shipped UPS unless otherwise requested.

Charge To: Ship To:
Address: Address:
Address: Address:
City, State, Zip Code, Country:


 City, State, Zip Code, Country:
_____Definite Order _____Definite Order, P.O. to follow Definite Order
P.O. No.: ________________

Credit Card Information if needed (Please circle: MasterCard or Visa)

Credit Card Number: ________________________________ Exp. Date: ______________

Home Phone: ______________________ Work Phone: ______________________

Qty Type Title/Composer/Arranger Pub. / Cat. #
       
       
       
       
       
       
       

Comments or special instructions:

 

Southern Music Company - P.O. Box 329, 1100 Broadway, San Antonio, Texas 78292 U.S.A.
24-Hour FAX: (210) 223-4537 | Phone: 1-800-284-5443 or (210) 226-8167
© 1997 Southern Music Company