ORDERFORM 
 TALKING HEADS TRIBUTE CD    DON'T WORRY ABOUT THE COVERBAND


Please fill in this form to order your copy of the CD "Don't Worry About the Coverband". Select your preferred payment method below and fax or mail this form to:

Studio Zimbra
Talking Heads Tribute CD
PO Box 84132
2508 AC Scheveningen
The Netherlands

Fax: +31-70-3585058

Shipping address

Name : 		________________________________________

Address: 	________________________________________

		________________________________________

State / Zip :	________________________________________

City :		________________________________________

Country :	________________________________________

Email : 		________________________________________


Select shipping method :

O	10 US$ (standard airmail shipping)
O	15 US$ (priority airmail shipping)

Select payment :

O	CASH PAYMENT ENCLOSED
	Note: cash US dollars only !
O	CREDIT CARD  
Note: credit cards will be billed in Dutch guilders only. The final price on your credit card bill might be slightly lower or higher than the estimated price in US$.

Card type:	O 	VISA
			O	Mastercard
			O 	American Express

	Card number :	__________________________________________

Expiration Date :	___________________

Name on Card :	__________________________________________


	Signature :	______________________________________
											[end of document]