WINDS QUIET SOUND® PO Box 975 Pioneer, Ca 95666 (Phone/Fax: 888/901-7340) www.windsquietsound.com

Date:

Name:                                                                                          Phone:

Delivery Address: (Mailing Address: )

City:                                                                               State:              Zip:

Instructions: Please give a complete description of the item(s).

Quantity              Item Description                                                                Amount

Name as it appears on card;__________________________________________signature_________________________________________

Please circle one --------- Visa----------Mastercard------------------- card number____________________________________________

expiration Date mm/yy----______/_______ Three digit security code on back of card________________

Circle one: Choice of wood for block - Cherry or Walnut	N.C.
Merchandise Sub Total
Calif. Sales Tax 7.25%(if applicable)
*Shipping and Handling
Total Amount
Subtract Order Deposit 50%
Balance Due Before Delivery