Antique Vinyl Order Form
(Fax or mail a separate order form for each album)

Mail to: Antique Vinyl • 3230 Robinson Dr• Oakland, CA 94602

Phone-in: (510) 759-2120 • Fax-in: (510) 530-1235

Date_______________

Album Title___________________________________________________

____________________________________________________________

Part Number___________

Price $_________ (CA residents add 8.75%)

Shipping Type________________________________________________

Total Including Shipping $_______________

Shipping Information

First Name_______________ Last Name______________________

Address_______________________________

City__________________________________

State/Province_________________________ Zip__________

Country_______________________________

Phone____________________________ Fax____________________________

E-mail________________________________

Payment Information
(Make checks payable to Antique Vinyl)

_Check/Money Order  _Mastercard   _Visa 		

_Discover  _Certified Check 

Credit Card Number_________________________________

Exp. Date______________ 
Or
Call for Credit Card Number_(___)_____-_________________