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NEW PIANO PRICING GUIDE FORM #2 (for fax and mail submission)       

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Name: __________________________________________________________________   

Address: _______________________________________________________________   

________________________________________________________________________   

City: __________________________________ State/Prov.: _______      

Zip/Postal Code: _______________ Country: ___________________        

      

Credit card:  ___ MasterCard   ___ Visa   ___ Amex   ___ Discover/Novus        

Card #: ______________________________  Exp. date (month/year): ________       



Please send me price information on the following new piano models.     

I understand the cost of this service is US$25.00 for the first three pianos

requested (minimum US$25.00), plus US$5.00 for each additional piano.

Please charge my credit card accordingly.     
     

Signature: ___________________________________         

     

PIANO #1: Brand ____________________  Model (letters, numbers) __________       

Style/finish (e.g., Satin Ebony, French Provincial High-gloss Walnut, etc.)     

________________________________________      
   

PIANO #2: Brand ____________________  Model __________      

Style/finish ________________________________________   
 

PIANO #3: Brand ____________________  Model __________     

Style/finish ________________________________________   
  

PIANO #4: Brand ____________________  Model __________      

Style/finish ________________________________________   
   

PIANO #5: Brand ____________________  Model __________     

Style/finish ________________________________________   
 

PIANO #6: Brand ____________________  Model __________     

Style/finish ________________________________________   

   
For additional models, please submit another form or use an extra sheet of paper.     

Please tell us how, and to where, you would like the information sent:      

___ By mail to the address given above     ___ By fax to: ____________________   

___ By e-mail to: ______________________________   
  

Mail this form to:        

	Brookside Press      
	P.O. Box 300168     
	Jamaica Plain, MA 02130      
	USA          

Fax this form to: (617) 390-7764
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Copyright 2006 by Brookside Press.  All rights reserved.      

For more information, contact: info@pianobook.com