Print this form, and send with your order

 

Ship To:
Name ___________________________________ Phone_____________
Address____________________________________________________
City ________________________  State _______ Zip Code__________

 

Qty

Item

Price

Ext Total

  Compact Disc, "The Other Half, 2007

15.00

 
  Compact Disc, "One For Me", 2003

12.00

 
  T-Shirt, Chris Himel, The Other Half

12.00

 
  T-Shirt, Chris Himel & Outbound

12.00

 
 

 

SUB-TOTAL

 
 

Add 2.50 per item

SHIPPING

 
 

 

TOTAL

 

Send check or money order, for the total amount to:

Chris Himel

147 Gena Marie Dr

Lafayette, LA 70506