Print this form, fill it out completely and mail or fax to the address below. 

 Contact and Billing Information

Contact Name:____________________________________________________________________________________


Address:________________________________________________________________________________________


City, State, Zip:_______________________________________________________________________________


Phone number:____________________________________FAX: ________________________________________


E-mail address:_________________________________________________________________________________


Semi-Customized Program			          	     Fully Customized Program
						   |
Music Selection : 1- Jazz			   |       Number of the music selected from our  
(choose one)	2- Classical			   |       Music Samples page.
		3- Rock				   |
		4- Seasonal			   |          1. _______  2. _______  3. _______  4. _______
						   |
						   |
Script Information				   |
Company name to be used in Script		   |        Submit pre-approved script for customized programs.
						   |
________________________________________	   |
						   |
Business Hours _____________________________	   |
						   |
Fax # _________________				   |
						   |
Website address _____________________________	   |
						   |

Current player and model # _____________________________________  

				Delivery method: Cassette, CD, FTP/Web, other: ________________

Method of payment

             Check/Money Order         Visa         Mastercard     DiscoverCard    AMEX


Name as it appears on the card:_________________________________________________________________


Card Number: ____________________________________________________  Expiration:__________________ 


Zip code for billing address:______________     CVV2 #_________________________
                                       (That 3 digit # AFTER the credit card number in the signature area.
					Or the 4 digits on the front of an AMEX card.)


Signature:________________________________________________________


Are you a returning customer?_________________________________________

This form must be used for Credit Card orders.

Avocado Productions
9873 Zephyr Dr	
Broomfield, CO  80021
fax - 773-439-5706
email - info@avocadoproductions.com


											03/09