ORDER FORM

Copy & paste this form in an email to clogstuff@perrysplace.com or post to:

Perry's Place Records & Supplies, PO Box 69, Nicholasville, KY 40340

Name___________________________________Phone____/_____/_____________

Address_____________________________________________________________

MUSIC, TAPS, EQUIPMENT, AND ACCESSORIES:

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SHOES:

Style                  Size        Width        Color        Quantity        Taps        Comments

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For shoes, domestic shipping: $10.00 for the first pair, $2.50 for the second, $1.00 each additional pair same order. For other products, please see the information for that product. If not specified, or if you have any questions, please call our 24-Hour Order Hotline at 859-885-9235 or 800-882-3262. We look forward to being able to help you!

Add $8.50 for COD.
Amount for merchandise $
Kentucky res. add 6% ___________
Shipping & handling_______________
Total Enclosed: $____________.______    Paypal: ____
Or Visa____ MC____ Discover____ # ________ - ________ - ________ - _________
Expiration Date: ______________________