Cedar
Mountain Drums2237 East Burnside, Portland, OR 97214-1653
(503) 235-6345 Fax: (503) 230-0843 patrick@cedarmountaindrums.com
Order Date__________________
Ship to: Billing Address (if different):
Name:____________________________________________ Name:_______________________________________________
Company:_________________________________________ Company:____________________________________________
Address:__________________________________________ Address:_____________________________________________
City:___________________ State or Province: __________ City:______________________ State or Province: _________
Country: _______________________ Zip:______________ Country: ___________________________ Zip:_____________
Phone: _____________________________________________ Email:_______________________________________________
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Check, Money Order or Bank Draft enclosed: _______
Number_________________
(please call to verify shipping charges)
Master Card _____, Visa _____, Amex _____, Discover _____
Card Number: ___________-___________-___________-___________ Expiration Date: ___/___
3 digit code (last three numbers on back of card, 4 digit for AMEX) ________
Signature: [name as on card] _____________________________________