Country Lane Music Order Form

*My Name:

*My Email address:

*Type it again:

*Ship to: Me ...or as a gift

As a gift to:

Enclose gift card saying:
: From:

*Complete Shipping Address:

*Now select from either Colum A or B below:

A. Shipments to the US
All Shipping & Handling charges are included

B. Shipments OUTSIDE the US
All Shipping & Handling charges are included

Cabin in the Rain How many?

Om Magic How many?

Total CD's

Cabin in the Rain How many?

Om Magic How many?

Total CD's

My $ Total Payment is: $

Total # Ordered ... Total Cost

1 ... $18.25
2 ... $30.
3 ... $39.
4 ... $48.
5 ... $57.
6 ... $67.
7 ... $77.
8 ... $87.
9 ... $97.
10 ... $106.
11 ... $116.
12 ... $126.
13 ... $136.
14 ... $146.
15 ... $156.
16 ... $166.
17 ... $176.
18 ... $186.
19 ... $196.
20 ... $205.

My $ Total Payment is: $

Total # Ordered ... Total Cost

1 ... $22.
2 ... $35.
3 ... $46.
4 ... $55.
5 ... $64.
6 ... $74.
7 ... $85.
8 ... $95.
9 ... $105.
10 ... $115.
11 ... $125.
12 ... $135.
13 ... $146.
14 ... $156.
15 ... $166.
16 ... $176.
17 ... $188.
18 ... $198.
19 ... $208.
20 ... $218.

*Method of Payment

Sending Check/Money Order: to Wholarts POB 2963 Stateline, NV 89449 U.S.A.

Faxing this page to 801.409.6790. We accept MasterCard, Visa, American Express, Optima.

Card #: Expiration date: Example 04/03

Name on card:

STOP: if this is NOT your personal or business card, you must fax signature of card owner and permission to charge (801.409.6790) 24 hrs.

Credit Card Address (Skip ONLY if shipping address and credit card billing address are the same.)

*Signature for credit card purchases: (type your name)
By signing this order, I assert that I am legally qualified to make this purchase and have accurately represented my charge card information (if ordered that way), as well as my name and other information relevant to this order.