MUSIC & VIDEO CATALOG

Al Meixner Mail Order Music                                              CD, Cassette & DVD Order Form
5562 Route 145, Laurys Station, PA 18059
Customer Name_______________________________________________________
Address_____________________________________________________________
City, State, Zip________________________________________________________
Phone Number (_____)___________________________ Date__________________
Qty. Serial #                                     Description                                      Cost
. . . $
. . . $
. . . $
. . . $
. . . $
. . . $
. . . $
Merchandise Cost $
                                 Pennsylvania Residents Must Add 6% Sales Tax Here $
Shipping and Packaging Charge (per order)

$     4.00
TOTAL AMOUNT DUE $
Remember, Order 3 or more items and there is no shipping charge !!!
(For this special deal, all items ordered must be shipped to the same address)
Method of Payment (Sorry, No Cash or C.O.D.s)
( ) Check or Money Order Enclosed – Payable to: Al Meixner
( ) Visa     ( ) Mastercard     ( ) Discover
Credit Card # _____________________________ Exp. Date_________
Signature ______________________________________________________
If you wish, you can credit card order by phone (610) 261-3881
between the hours of 3 P.M. and 7 P.M., Monday through Friday - Eastern Time
*** leave a message between 9 AM - 3 PM ***
If you wish, you can credit card order by fax (610) 261-3882 Anytime.