Murch Music Fax Order:
(Please Print)
Murch Music Inc.
1490 Dunbar Road
Cambridge, Ontario
Ship To:
Name:
______________________________________
Address: ______________________________________
City
- State/Prov ______________________________________
Country:
______________________________________
Zip/Postal Code: ______________________________________
Daytime Telephone : ______________________________________
Email
Address (for tracking number) ___________________________________
Please
charge my credit card for the purchase of
_________________________
at a price of __________________ plus shipping and all applicable taxes.
Type of
Card (Visa, Mastercharge or American
Express) _______________________
Card
Number:
__________________________________
Expiry
Date:
___________________________________
Name as it appears
on the card:
_______________________________
Mailing
address that the statement goes to if different from shipping address:
______________________________________
______________________________________
______________________________________
Customer
Signature: ______________________________