Black Swan Merchandise Order Form

Contact and Shipping Information
Your Name:   Order Date:  
Address:  
City, State, ZIP:  
Country:   Telephone:  
 
Card Type
Circle one:
Visa
MasterCard
AMEX
Discover
Card Number   Expiration  
Name on Card  

Signature

 
RECORDING TYPE
QUANTITY
PRICE EACH
TOTAL
PRICE
Dance Hall Favorites (2010) NEW 2 CDs   $26.00  
Feel the Spirit (2007) CD  
$16.00
 
This Joint is Jumpin' (2005) CD  
$16.00
 
Ragtime Revelry (2003) CD   $16.00  
Mama's Gone Goodbye (2001) CD   $16.00  
A Joyful Noise - Jazz Gospel (2000) CD   $16.00  
 
ARRANGEMENTS ($12) or
COLLECTIONS ($99.99)
(Write in Title)
QUANTITY
PRICE EACH
TOTAL
PRICE
1. Title:   $  
2. Title:   $  
3. Title:   $  
4. Title:   $  
5. Title:   $  
 
OTHER ITEMS NEW

SIZE

QUANTITY
PRICE EACH
TOTAL
PRICE
Black and Gold Logo Shirt (Polo)   $30.00  
Shipping and Handling (Shipping included for USA orders - $5 additional postage for international orders)  
 TOTAL PURCHASE  

Please send this completed form along with your check, money order or completed credit card information to:
Please allow two to four weeks for delivery.


Black Swan Classic Jazz Band
7785 S.W. West Slope Drive
Portland, Oregon 97225