Printable Credit Card Order Form

Name As It Appears on Card                                                                           
Email Address  
Street Address                                                                                               
City                                                                                                              
State                                            Zip                                                            
Telephone                                                     
Credit Card Type (visa or mastercard only)                                                        
Card Number                                                                                                  
Expiration Date                                                                                                
Signature
 
ITEM HOW MANY? PRICE PER ITEM TOTAL AMOUNT
The Kennedys "Positively Live?" $15.00
Subtotal:
SHIPPING 
($1 PER ITEM):  
TOTAL:

 

PRINT THIS PAGE, FILL IT OUT AND FAX YOUR ORDER TO: 703-834-6226
THIS IS A SECURE FAX LINE.
IF ORDERING BY CHECK, PLEASE MAKE CHECK PAYABLE TO "THE KENNEDYS" AND SEND TO:
JIFFYJAM RECORDS
PO BOX 8461
RESTON, VA 20195

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