Jim
Del
FOCUS
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Mail-Order Form
Delivery Information
Name(s): __________________________________________________
Street Address:__________________________________________________
City:________________________________ State:________ Zip Code:__________________
Purchase Information (please circle one column)
Quantity :
1
2
3
4
16
94
Price per CD:
$9.99
$19.98
$29.97
$39.96
$159.80
$939.06
Shipping per CD:
$1.40
$2.00
$2.40
$2.40
$4.00
(it's on me)
Total:
$11.39
$21.98
$32.37
$42.36
$163.80
$939.06
Type of Payment (circle one):
Check Money Order
you can expect your stereophonic cd, chock full 'o progressive pop music, to arrive within 3-5 days upon receipt of order
Feel free to take a moment to complete the following questionnaire (thankyouverymuch)
How did you hear about FOCUS?
Would you be interested in seeing JimDel and The Focus Group live in concert? (Y or N)
Would you like to be contacted via email with information of upcoming shows and events? (Y or N)
Email Address: __________________________________________________
Are you left-handed? (Y or N)
Can you curl your tongue? (Y or N)
Do your windshield wipers distract you while you are driving? (Y or N)
How are you feeling? (Y or N)
Have you ever thought about, felt deeply for, then acted upon something real? (Y or N)
Send Order-Form & Currency to:
Adrenalin Records
285 Main Street
Northport, New York 11768
C/O: FOCUS