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