Electric Head Records & TimeStyle Music Records Online Store -Website:
www.secondcomingmusic.com & www.electricheadrecords.com
8554 122nd Ave NE, PMB A-201 Kirkland, WA 98033 - Email: info@electricheadrecords.com or Fax: 425-482-9614Name:___________________________________________Date:____________________
Street:___________________________________________________________________
City:_______________________Prov/State:__________Zip/PostalCode:______________
DaytimePhone:_________________Fax:_________________Country:________________
Email_______________________________Phone:_______________________________
MC__ or Visa
__ ---------(please circle
one)----------
(credit card charges will appear as: TimeStyle Music Records)
Name on
Card:_____________________________________________________________
Card Number:______________________________________________________________
Expiration
Date:___________________Signature:_________________________________ |