BLOODWORK RECORDS ONLINE MAIL ORDER
Print this form, fill it out and WRITE CLEARLY! - Include it with your order.
If you don't have a printer, hand write CLEARLY, all necessary info on a sheet of paper and include it with your order.

NAME: _________________________________________________________________________________

ADDRESS: ______________________________________________________________________________

CITY: ____________________________________________STATE: ________________________________

ZIP, POSTAL CODE: ____________________________COUNTRY_________________________________

E-MAIL ADDRESS: ________________________________________________________________________

MERCHANDISE
QTY OF: _______DRCHUDS X-WARD - Diagnosis for Death / MCD / BW4464 ........$12.99 each.....= $___________
QTY OF: _______DRCHUDS X-WARD - Diagnosis for Death / LE VINYL/ BW4465..$14.99 each.....= $___________

Shipping Cost (CD only) - (1 - 2 Items) (Add $.50 for each additional item)
US $3.50 Standard Flat Rate Shipping Service United States Only
US $5.00 Standard Int'l Flat Rate Shipping Americas
US $7.00 Standard Int'l Flat Rate Shipping Europe
US $9.00 Standard Int'l Flat Rate Shipping Worldwide E-MAIL us at bloodworkrecords@hotmail.com

Shipping Cost (VINYL only) - (1 - 2 Items) (Add $1.50 for each additional item)
US $5.00 Standard Flat Rate Shipping Service United States Only
US $6.50 Standard Int'l Flat Rate Shipping Americas
US $8.00 Standard Int'l Flat Rate Shipping Europe
US $10.00 Standard Int'l Flat Rate Shipping Worldwide E-MAIL us at bloodworkrecords@hotmail.com

TOTAL # OF ITEMS ........................................................................____________
TOTAL PRICE OF SHIPPING..................................................... = $____________
TOTAL PRICE OF ITEMS........................................................... = $____________
GRAND TOTAL ENCLOSED...................................................... = $____________

All orders must be payed in the form of International or U.S. Money Orders, or
well conceled U.S. Cash, or Cashiers Check..
NO PERSONAL CHECKS WILL BE ACCEPTED!
NO C.O.D'S, NO FORIEGN CHECKS!
Payment in full must accompany order.
Allow 1- 3 weeks for delivery
SEND MONEY ORDER PAYABLE IN U.S. DOLLARS, MADE OUT TO "CASH" or "BLOODWORK RECORDS"
All checks NOT made out to "Cash" or "Bloodwork Records" will be sent back.

Mail To:
BLOODWORK RECORDS
P.O. Box 16,
Lodi, New Jersey
07644
U.S.A.