Send this form along with
check or money order to:


John Nagy
8160 New Liberty Road
Maysville, IA 52773
USA

Please print clearly.

Name: ___________________________________________
Address: ___________________________________________
City: ___________________________________________
State: ___________________________________________
Postal Code: ___________________________________________
Country: ___________________________________________
Email: ___________________________________________
Phone: ___________________________________________

All funds are in US Dollars (USD).

  Quantity Item Code Cost Each Line Total
Example: 2 N-108 9.95 19.90
Item #1        
Item #2        
Item #3        
Item #4        
Item #5        
Shipping Charges
Shipping Rate Item Subtotal
$4.50 $0.01 - $14.99
$6.50 $15.00 - $29.99
$8.50 $30.00 - $59.99
$10.50 $60.00 - $79.99
$12.50 $80.00 and up
Shipping for larger/heavier items will be arranged separately. Contact john@phonographs.org for a shipping quote.
Sub-Total:  
Tax (7%):
(IA residents only)
 
Shipping:
(based on Sub-Total)
 
Grand Total:  

You will be contacted by email regarding the shipment of this order.

Thank You!