XLPC Theremin - Check / Money Order Form - Please print this form!

First & Last Name:
 _______________________________
Address:
 _______________________________
Apt, Suite, Unit:
 _______________________________
City, Town:
 _______________________________
State, Province:
 _______________________________
Zip/Postal Code:
 _______________________________
Country:
 _______________________________
E-Mail Address:
 _______________________________
Telephone:
 _______________________________
XLPC Theremin - $64.95:
 QTY:__________ Total Price:____________
Mini XLPC Theremin - $62.95:
QTY:__________ Total Price:____________
Flex XLPC Theremin - $72.95:
QTY:__________ Total Price:____________
Motorized XLPC Theremin - $86.95:
QTY:__________ Total Price:____________
DOME XLPC Theremin - $69.95:
QTY:__________ Total Price:____________
DOME Flex XLPC Theremin - $69.95:
QTY:__________ Total Price:____________
Alien Head XLPC Theremin - $72.95:
QTY:__________ Total Price:____________
Dice XLPC Theremin - $72.95:
QTY:__________ Total Price:____________
Revolving Ball Disco Lamp XLPC Theremin - $76.95:
QTY:__________ Total Price:____________
Stop Lite XLPC Theremin - $66.95:
QTY:__________ Total Price:____________
Sub Total:
 QTY:__________ Total Price:____________
Shipping & Handling for XLPC & Mini Theremin is $7.50, Flex, Motorized, Dome, Dome Flex, Alien Head, & Dice is $9.50, Stop Lite & Disco Lamp is $10.50. All shipping prices are for U.S. Buyers Only! International buyers please e-mail first! djssell@verizon.net. Please contact us for a shipping quote if you are ordering more than one unit. All prices are listed in USD!

Shipping:

 $_________
Grand Total/Amount Enclosed:
 $_________

Please make your Check / Money Order payable to: Donald Stanley

Mail to:
Donald Stanley
47 Taplow St.
Warwick, RI 02889
United States		 If you are sending a Check / Money Order from outside the United States please make sure it's drawn from a United States bank or is an International Postal Money Order. Otherwise we cannot cash your payment and this will delay your order. If you send a personal check we must hold the order for a minimum of 10 days to verify the check has cleared the banks.