Interactive Order Form


Please
Note...
Azica will calculate all costs based upon Pricing information on previous page -- please do the same if you wish to include a bank check or money order
with your mailed order
Please Note -- Azica regrets that it cannot accept personal checks
If you are using FAX or regular mail, please print this page and use it as your order form
If you wish to pay by credit card, please include credit card information below
Please do not include cash with any mailed orders
 

Part I - Please tell us about yourself...

Name:
Email:
Street
Address:
City:
State:
Zip:
Telephone:

Part II -
Please Select Your Purchases

Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description
Quantity   Product #   Description

Part III -
How do you wish to pay for this order?

Payment
Options...
 
Money Order
please include with mailed order
VISA
MasterCard
  If Using a Credit Card...
Name on card:
Card Number:
Expiration Date:

Part IV - Comments?


Part V - Send in your order...

Please note that the security of this information cannot be guaranteed as you post it over the web!


If you wish to re-enter your information, please press this button:


 

Thank you for your order...
Your interest in Azica is valued highly

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Azica Records, Inc. 
2001 Azica Records, Inc.
email egre@azica.com