LesterQ.com United States order form

please print form and complete by hand or create a reasonable faxsimile

CD	PRICE	SHIPPING	QUANTITY	FORMAT
Oh My!	$17 USD	Free!	[____]	CD
So Here We Are	$15 USD	Free!	[____]	CD
Tri-Continental Live (2 CD)	$28 USD	Free!	[____]	CD
A Big Love	$15 USD	Free!	[____]	CD
Keep On Walking	$15 USD	Free!	[____]	CD

All prices are in US funds and include shipping. Payment must be made by money order or cheque.

Please make cheques payable to Poetical License Inc. and send to:

Poetical License Inc.
Box 135
Pender Island, B.C.
V0N 2M0, Canada

Name:
__________________________________________________

Address:
__________________________________________________
__________________________________________________
__________________________________________________

Email address:
__________________________________________________