Whipkey's Music ORDER FORM

THIS FORM IS TO BE USED ONLY AFTER YOU HAVE BEEN GIVEN A VERBAL QUOTE ON THE INSTRUMENT YOU ARE PURCHASING IN CONJUNCTION WITH COPIES OF BOTH SIDES OF YOUR CREDIT CARD AND DRIVER’S LICENSE.

______ INITIAL HERE to indicate that you have read and understand the store policy stated on the web site regarding TERMS, RETURNS, SHIPPING and DAMAGE and understand how to order using charge cards.

Date: ____/____/____

CUSTOMER & SHIPPING INFORMATION:
NOTE: If this purchase is to be put on a charge card, address information below must match cardholder’s billing address. Remember, UPS DELIVERY cannot be made to a P.O. Box.

Customer Name: ___________________________________________________

Customer Address: _________________________________________________

City:__________________________________ State: _______ Zip: __________

Phone: (______) __________________ Work: (______) __________________

E-mail: __________________________________________________________

INSTRUMENT DESCRIPTION:

Brand: _________________________Model: _______________________Type: _______________________

METHOD OF PAYMENT:(Check one below)
Make checks payable to WHIPKEY'S MUSIC
REMEMBER: Charge card orders require copies of both sides of your credit card along with a copy of your driver's license.

___Cashier Check ___Money Order ___VISA___MasterCard___Discover

Credit Card # _______________________________________________Exp. Date: ____/____

Name on Card:________________________________________________________________

Driver’s Lic # __________________________________State: _______ Exp. Date ____/____/____

Instrument cost	$________________._____
Sales Tax (if applicable)	$________________._____
Shipping	$________________._____
TOTAL amount to be charged	$________________._____

Card Holder Signature:______________________________________________________________

SPECIAL REQUESTS: ______________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

FAX with credit card intormation to (770) 422-2570. --- OR --
MAIL with check made payable to WHIPKEY'S MUSIC, 2949 Canton Rd - Suite 700, Marietta, GA 30066
IF YOU MAIL this form ... DO NOT FAX