Name:_____________________________________

Mailing Address:____________________________

__________________________________________

City/Town:______________________ State:_____ Zip: ________

____ Jazzmosis: the CD(s) at $14.99

____ Jazzmosis: Baker's Dozen at $14.99

please include $2.50 shipping and handling for up to 2 CDs, $3.50 for 3 to 5 CDs and $6 for 6 to 30 CDs.

____________ Total order

Please Mail this form, along with your check or money order (made payable to Jack Phipps) to:

Jazzmosis
109 Meadow Road
Milton, VT
05402-422

Thanks for your order! Would you like to be added to our Mailing list?

___Yes, I would love to hear from you again!

___No, I think you're creepy and I'll contact you on my own terms.

E-Mail Address ______________________