[=- M E D I A -=] [=- D E T O X -=] [=- M U S I C -=] import music distributors Order Form Mail Orders to: MEDIA DETOX 2671 Eglinton Ave East., Suite #131, Scarborough, Ontario, M1K 2S2 CANADA Ship to:____________________________________________________ Address:____________________________________________________ ____________________________________________________ ____________________________________________________ Telephone: ( )____________________________________________ (include all country and area codes) E-mail: ____________________________________________________ (Print clearly. E-mail is required for all correspondence) Would you like an e-mail notice that we have shipped your order: Yes No Print all information. Illegible orders cannot be processed. Shipping to US or Canada is $2.00 per item. Maximum charge is $12.00. Add an additional $2.00 per item for foreign orders. (No maximum on foreign orders). Artist(s) Selection Title Format Price _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ _________________ ______________________________ ______ _____ Subtotal $______ Shipping $______ Total $______ Total Items Order: ______ Payments are accepted by CASH ONLY NO CHEQUES. NO CREDIT CARDS. NO MONEY ORDERS. NO EXCEPTIONS. ALL ORDERS IN US DOLLARS ONLY!!!! Special Instructions:_______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________