John Proulx - Moon and Sand

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Print this form and send with your check or money order

First Name: _________________________________________

Last Name: _________________________________________

Address:     ________________________________________________

                 ________________________________________________

City:          ____________________ State: ______ ZIP: ____________


I would like to purchase:     CD - Moon and Sand

Quantity: ________

Price of CD includes shipping & handling:

US orders:                 x  $18.00 =  

Total Price: ____________

Canada & Europe:       x  $22.00  =

Total Price: ____________

Other International:    x  $28.00  =

Total Price: ____________

Mail checks or money orders to:

     John Proulx
    4605 Cahuenga Bl. #317
    Toluca Lake, CA 91602