HAGA FAMILY CD ORDER FORM

Please print this form and send it in with your order. Right click and choose print.

NAME_____________________________________________________________________
STREET ADDRESS__________________________________________________________
CITY______________________________ STATE _____ ZIP _______________________
PHONE:_________________________ FAX_______________________________
(Please Type of Print)

Please fill in all blanks that apply to you:

How Many CD's__________
Ship to if address is different from above.
NAME _______________________________________________________________________
STREET ADDRESS ____________________________________________________________
CITY _________________________________STATE _______ ZIP _____________________

Cost per CD$ 25.00Shipping$ 2.00Total per CD$ 27.00

For more than one CD to same address, add $1.25 for each additional CD for shipping, and

Method of payment (circle one) Check Money Order Total payment enclosed. $______________

Make checks payable to James M Haga and mail order and payment to:

James M Haga

6221 West Lee Hwy

Rural Rtereat Va. 24368

Allow about 2 weeks for delivery. Sorry, but I cannot accept credit cards.
Checks or Money Orders only.