PRINTABLE
ORDER
FORM
 WESTERN INTERNATIONAL MUSIC, INC.
3707 - 65th Avenue | Greeley, CO 80634-9626
Ph: (970) 330-6901 | Fax: (970) 330-7738 | E-mail: wimbo@wiminc.com
 CUSTOMER INFORMATION
NAME
SHIPPING ADDRESS  (IF DIFFERENT)
COMPANY

NAME
ADDRESS
COMPANY

CITY
ADDRESS
STATE
CITY
ZIP CODE
STATE
COUNTRY
ZIP CODE
PHONE

COUNTRY
FAX
SPECIAL
INSTRUCTIONS
E-MAIL

CATALOG ORDER INFORMATION (please use a separate sheet to order additional items)
 QUANTITY
  CATALOG
NUMBER		  COMPOSER TITLE INSTRUMENT PRICE 














































































METHOD OF PAYMENT:
___MasterCard  ___VISA    ___Wire Transfer

___Check or Money Order (enclosed)
___Institutional Purchase (use official stationery)

___________________________________________
MasterCard or VISA Card Number

___________________________________________
Expiration Date (month/year)

___________________________________________
Cardholder Name (please print)

___________________________________________
Signature (required for credit card transactions)
TOTAL
Shipping & Handling - Domestic (if total is $25.00 or less): $4.40
Shipping & Handling - Domestic (if total is more than $25.00): $5.60
Alaska & Hawaii (if total is more than $25.00, CONTACT us for S&H charges)
Shipping & Handling - Foreign (if total is $25.00 or less): $7.00
Shipping & Handling - Foreign (if total is $25.00 to $60.00): $11.00
Shipping & Handling - Foreign (if total is over $60.00): $15.00
Each wire or check drawn on a foreign bank: $15.00
For Colorado residents, add 2.9% sales tax.
GRAND TOTAL