Ragtime Automated Music
4218 Jessup Rd., Ceres, CA 95307 U.S.A.
Telephone: (209) 735-0767 FAX: (209) 634-2667
Orders: (209) 634-8475
 

1.NAME AND ADDRESS (please type or print) Daytime Telephone (____ ) __________________________  2.SHIP TO (if different from above - street address necessary for UPS)  City State Zip  Daytime Telephone (____ ) __________________________

3.PAYMENT METHOD (Please check)  CHECK ENCLOSED  DISCOVER  VISA  MASTERCARD  AMERICAN EXPRESS  CARD NUMBER  EXPIRATION DATE: CARDHOLDER'S NAME SIGNATURE

4. CAREFULLY READ SHIPPING & PAYMENT TERMS BEFORE COMPLETING THIS FORM
 

Catalog Number	Name of Item	Quantity	Page	Color/ Model	Price Each	Total
Occasionally we may become short on certain parts or rolls. Please answer below. If no, we will charge you only for what is shipped and notify you when the back order is in stock. Will accept substitute Yes/No Do not substitute.        Yes/No		Merchandise Total
		California Residence please include the appropriate Sales tax for your area.
		Shipping & Handling (will be added by Shipping Department)
		TOTAL ORDER

BUSINESS HOURS: MONDAY THROUGH FRIDAY - 8:00 A.M. TO 5:00 P.M. (Pacific Standard Time) feel free to call (209)667-5525 to make an appointment for weekends or after hours.

Print this out and Fax it to (209)634-2667

Fax Orders: 209 634-2667	Phone: 209 667-5525	Phone Orders: 209 634-8475
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