Order Form
Mail orders to:

  Rotten Records
  P.O. Box 56
  Upland, CA 91786 USA
  Phone: (909)920.4567
  Fax: (909)920.4547 		  

Name: ________________________________________________
Address: ________________________________________________
City: __________________   State: ______   Zip: __________
Country: ___________________   Phone#: ___________________
E-mail: ________________________________________________


IF ORDERING WITH A CREDIT CARD, PLEASE COMPLETE THIS SECTION
Card Type: ________________________________
Card #: ________________________________
Exp. Date: ___________________


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signature

Item # Description Quantity Price
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Flat Rate Shipping of $5 for orders over $13
(FOR U.S. ONLY)
$5.00
       
 
Contact us for shipping cost outside of the U.S.
 		Total: _________


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