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
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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. _______
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Script Information |
Company name to be used in Script | Submit pre-approved script for customized programs.
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________________________________________ |
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Business Hours _____________________________ |
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Fax # _________________ |
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Website address _____________________________ |
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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