BIRCH CREEK
MUSIC PERFORMANCE CENTER, INC.
2010
PRINTABLE CD ORDER FORM

Print and fill out this form and fax or mail it with your payment or credit card information.

If you wish to send your order to an adress other than your billing address,
please place your order by phone Monday-Friday 9 am - 4 pm.
Phone: 920-868-3763

Fax: 920-868-1643
 Birch Creek
P.O.Box 230
Egg Harbor, WI 54209-0230


Regular CD prices: Three Miles East (30th Anniversary CD) $15
 Silver Celebration (25th Anniversary CD) $10
Shipping $3.00 per each shipping address.
AMOUNT
_____ Three Miles East CDs @ $15       
$_______
_____ Silver Celebration CDs @ $10       
$_______
TOTAL FOR CDs =
$_______
CD MAILING FEE =
 $ 3.00
 TAX DEDUCTIBLE DONATION =
 $_______
TOTAL PAYMENT ENCLOSED
(All prices include applicable sales tax)
$_______
Mailing Name: ________________________________ Mailing Address: _____________________
City/State/Zip: _________________________________ Phone Number: ______-______-_______
  My check / money order is enclosed
Please bill my      Visa        MasterCard        Diners Club        Discover

Name on Card: (Please Print) _____________________________________________________
Acct. no. ____________________________________ 3-digit V-code________ Exp. Date__________
Signature________________________________________________________