Printable Order Form

	Sign In Sign-Up

Printable Order Form

Name:_________________

Shipping Address:____________________________

____________________________

Phone: ( ) -

Date: / /

Shipping and handling (See chart at bottom of page)	$
Total	$

Method of payment (Make checks or money orders payable to Dan Nixon):

Check___ Money Order___ Cash___

Complete printed form and mail to:

Proletariat Records

320 1/2 W. Maple St.

Mt. Pleasant, MI 48858

Thank You!