Print Out Order Form

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Bill To Address:
Name__________________________________________________
Address_______________________________________________
______________________________________________________
City______________________ State______
Zip Code/Postal Code________________
Country_________________________________
Day Phone_______________________________________
e-mail__________________________________________

Ship To Address:
Name__________________________________________________
Address_______________________________________________
______________________________________________________
City______________________ State______
Zip Code/Postal Code________________
Country_________________________________
Day Phone_______________________________________
e-mail__________________________________________

Payment Information:
( )Check
( )Money Order
Credit Card:
( )Visa
( )Master Card
( )American Express/Optima
Card Number_____________________________________
Expiration Date____________
American Express/Optima Cardholders: Please write the four-digit number printed on the front of your credit card above the raised card numbers_______________
Cardholder Signature_______________________________________

**Selections**
	Catalog No	Description	Quantity	Unit Cost	Total
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
	_____________	___________________________	_________	______	______
Total Unit Cost:
Shipping Charge:
Sales Tax (New York State Residents Only):
Total:

How To Order:
Please fax to: 1-518-833-0277, or
Mail to: REGO IRISH RECORDS.
P.O. BOX 1515
GREEN ISLAND, N.Y. 12183-0515
USA

Or Simply Call Us At 1-800-854-ERIN(3746)
For shipping costs, click here

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