FAX Direct Order Form

Direct Order Form
You can now choose to order product from The Jerry Naylor Company, LLC by mail or fax. Simply print this form, fill in the blanks and either mail it or fax it to us and we will complete your order as quickly as possible. Thank you for shopping at the Jerry Naylor Company Store!

Name:
Address:
City:
State:
Zip:
Country:
Phone:
Email:
Credit Card Type:
Credit Card Number:	Expiration:
Name on Credit Card:

Product Schedule
QTY	PRODUCT	AMOUNT
	Rockabilly Legends: A Tribute to My Friends CD	$12.99 USD
	CD Shipping - United States	$4.00 USD
	CD Shipping - International (3-Day)	$8.00 USD

Make Check or Money Order Payable to:
The Jerry Naylor Company, LLC
1301 North Highway 99W, No. 307
McMinnville, Oregon 97128 USA

Or FAX DIRECT to 1-503-435-0526

Your Signature: _________________________________________________