M O U T H P I E C E / R I M O R D E R FORM (Snail-Mail)
(Please print, complete and mail to: Moosewood, 9327 W. Briarwood Circle, Sun City, AZ 85351)
NAME_____________________________________________ DATE:_______________
ADDRESS__________________________________________
CITY______________________________________________
STATE/PROVINCE__________________________________ ZIP/Code_______________
COUNTRY_________________________________________
TELEPHONE ________________________________
E-MAIL_____________________________________
Note: Private Info is NEVER given out.
MOUTHPIECE MODEL?___ STANDARD WEIGHT? _____ Polished Brass?___
MEGA WEIGHT?____ Brass?___ CARTOUCHE? ___
Alexander or German stem? ____
RIM MODEL?________ in Delrin? ____ Gold Plate?__ TOTAL, incl. shipping/Paypal