Choctaw Creek Records Order Form

Please print this form, type or print your information, and mail it with your 
check or money order (US Dollars only, payable to "Choctaw Creek Records") to:

   Choctaw Creek Records
   810 South Larson
   Chanute, KS  66720

Your Name:       ________________________________________

Street Address:  ________________________________________

                 ________________________________________

City: ___________________ State/Province: _____________ Country: ___________ 

Zip/Postal Code: ___________ Phone: ____________ Email: ____________________




Title                                    Price       Quantity     Subtotal
----------------------------------------------------------------------------
Texas Johnny Brown                  | $15.00 each  |           |
"Blues Defender" (CCR10002)         |              |           |
----------------------------------------------------------------------------
Texas Johnny Brown                  | SORRY!       |           |
"Nothin' But the Truth" (CCR00012)  | SOLD OUT!    |           |
----------------------------------------------------------------------------
 ____________________________________                                      
| Shipping and Handling (US Dollars) |                Subtotal: ____________
|                                    |
| # of CDs  USA/Canada International |     Texas Residents add 
| -------   ---------- ------------- |         8.25% sales tax: ____________
|   1         $3.00       $6.00      |
|   2         $4.00       $7.00      |   Shipping and Handling
|   3         $5.00       $8.00      |     (Use table at left): ____________
|   4         $6.00       $9.00      |
|   5         $7.00       $10.00     |                   TOTAL: ____________
|                                    | 
| More than 5: Add $1.00 S&H for     |  Mail this form and your check or money
|              each additional CD    |  order (US Dollars only, payable to
|____________________________________|  "Choctaw Creek Records") to:
                                              Choctaw Creek Records
                                              810 South Larson
                                              Chanute, KS  66720
                                              


Thank you for your order. We will process it as quickly as possible. Please 
allow 4-6 weeks for delivery.  If you have questions or problems with your 
order, please email ccrinfo@choctawcreekrecords.com
Privacy Pledge:  We will not rent, sell, or give your personal information 
                 to anyone without your permission.