Order Form
To order:  fill in the form, send with check or credit card information to: 
Patrick Henry,  2807 Charlotte Lane Burlington, NC 27215
(Make checks payable to Patrick Henry)
Orders filled fast!   Shipping included within U.S.  1-615-491-3941
Send my order to: 

Name: ___________________________________________________________________

Address: _________________________________________________________________

City / State / Zip: __________________________________________________________
In the event of questions:

Phone: (      ) ________________________

        Email: _________________________

Music CD
Patrick Henry
$15.00 each

 
Quantity Comments or any Special Instructions Amount
_______ ______________________________________________ ___________

Subtotal:

 ___________

North Carolina Residents add 7% sales tax:

 ___________

(Shipping Included)  Total:

 ___________