Fax 1-802-229-0755.......Phone 1-800-472-SAMS

Mail.....GuitarSam - 89 Main Street/City Center - Montpelier VT 05602

Shipping Address

Name

Street Address

City

State

Zip

Billing Address (if different than your shipping address)

Name

Street Address

City

State

Zip

Payment Information

Payment Method...(Circle)...MC...VISA...AM-EX...NOVUS...Money Order...Personal Check (under $100.00 only)

Charge Card #

Exp.Date

Signature X

Security Code

EMail Address

Daytime Telephone

Evening Telephone

Here's my Order!

Qty.	Item #	Item Description	Price	Qty x Price
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.	.	Thank you for your Order! .........SUBTOTAL	.	.
.	.	Vermont residents, please add 6% sales tax.	.	.
.	.	FREIGHT (see shipping chart)	.	.
.	.	TOTAL ENCLOSED	.	.

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