The WorldWide Blues, Co.
"W h e r e  H i s t o r y  M e e t s  A r t"
Est. 1997
If your mailing address is a P.O. Box, please provide a delivery address.

ORDERED BY:

NAME ___________________________________________________________________________________

ADDRESS ____________________________________________________________APT._______________

CITY _______________________________STATE____________________________ZIP_________________

We'd like to send you special offers via email in the future.  Please send us your address.

EMAIL ___________________________________________________________________________________

SHIP TO: (if different from "Ordered By")

NAME ___________________________________________________________________________________

ADDRESS _____________________________________________________________APT.______________

CITY _______________________________STATE_____________________________ZIP________________


ITEM #  QUANTITYITEM DESCRIPTION   SIZE        UNIT PRICE  TOTAL PRICE

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

MERCHANDISE TOTAL ____________

Delivery in the United States is $5.50.  Everywhere else $10.50
                      DELIVERY CHARGES    ____________
       ____________

   ENCLOSED TOTAL    ____________

Enclose your personal check, bank check, money order or international money order.

Mail To: The WorldWide Blues, Co
        PO Box 480004
        Delray Beach, FL 33448-0004
        U.S.A
ORDER FORM
Please print and mail with proper payment