Midwest PRINTABLE ORDER FORMS Print 'em UP, Fill 'em IN & Send 'em OUT!

Qty.

ITEM #

Pg #

DESCRIPTION

COLOR/SIZE

UNIT PRICE

TOTAL

             
             
             
             
             
             
             
PAYMENT SHIPPING CREDIT CARD INFO Merchandise  Total  
square.GIF (71 bytes)VISA square.GIF (71 bytes)UPS Ground Card #: 8.5% Tax (IL Residents Only)  
square.GIF (71 bytes)Master Card square.GIF (71 bytes)UPS 2-Day Air Exp. Date: Subtotal  
square.GIF (71 bytes)American Express square.GIF (71 bytes)UPS 1-Day Air Customer Service #:
(from back of card)		 Shipping: $5.00 or 5%
whichever is greater		  
square.GIF (71 bytes)Discover

square.GIF (71 bytes)US Mail APO

Signature:

For COD add $5.25  
square.GIF (71 bytes)Cashiers Check

Can not process without signature. Must ship to cardholder's address.

Insurance (required)

$2.95

square.GIF (71 bytes)Personal Check TOTAL  

Mail To:
MIDWEST PERCUSSION 19027-B South Jodi Road. Mokena, IL 60448
1-800-282-DRUM

SOLD TO: SHIP TO: (if different from address at left)
Name Name
Address Address
City City
State/Zip State/Zip
Home Phone (          ) Home Phone (          )

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