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Dave Jorgenson
Order Form

Please print this form, provide the information below and mail together with your
check, money order, or credit card information to:

Ferguson Road Music
220 Elmer Cove
Kyle, TX 78640

 

We Have A Winner CD @ $15.00 each
Featuring 10 original songs		 Quantity__________ Total__________
Then and Now CD @ $12.00 each
Featuring 9 original songs		 Quantity__________ Total__________
Sales Tax @ 8.25% (Texas residents only)                         ___________
Shipping and Handling @ $3.00 per order     ___________
Total Order      ___________
Method of Payment (Please check the option you choose):
Check (enclosed)___________  Money Order (enclosed)______________
Credit Card:   Card Name_____________       Card Number________________________
                                Expiration Date:___________________
Shipping Information:
Name:____________________________________
Address__________________________________
City_____________________________________
State______________    Zip___________________
Phone____________________________________
Email_____________________________________
Thank you for your order.  Orders are shipped within 24 hours of receipt of order.
 
Be sure to visit us online at:  http://www.davejorgenson.com