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			Company Name_________________________________________________________ Your Name_____________________________________________________________ Address_______________________________________________________________ City, State, Zip__________________________________________________________ Phone Days___________________ Phone Nights & Weekends___________________ E-Mail________________________________________________________________  | ||||||
| Side | Track | Title | Time | Size | Speed | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
| A B  | ___ ___  | ________________________________________ ________________________________________  | ________ ________  | 12" | ¤ 33 ¤ 45 ¤ 33 ¤ 45  | |
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			 For each dub plate, give the following for A and B side: 
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			Tape Formats | 
			¤ Return tapes with order ¤ Hold tapes for future orders  | |||||
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			Payment: $92.00 for each twelve inch plate $10.00 Shipping/handling per shipping address, Priority Mail within US.  | ||||||