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House of Vibes Store Order Form
ALL OTHER COUNTRIES

Directions
1. Print order form
2. Complete
3. Mail order form and check to
House of Vibes
PO Box 4705
Highland Park, NJ 08904
USA
First Name: _____________________________ Last Name: ______________________________

Address: ________________________________________________________________________

Address: ________________________________________________________________________

City: ____________________________________________ State: ________________________

Zip: _____________________ Country: ______________________________________________

Would you like to be on the Grip Weeds' E-mailing list? Y or N

E-Mail: __________________________________________


FULL LENGTH ALBUMS
ITEM QUANTITY SHIPPING
Price Total Price Total
STRANGE CHANGE MACHINE DOUBLE CD (For Single CDs): 1 x $12.99 = $_____ + 1 x $4.99 = $_____
Additional CDs:
___ x $12.99 = $_____ + ___ x $4.00 = $_____

VINYL
ITEM QUANTITY SHIPPING
Price Total Price Total
STRANGE CHANGE MACHINE DOUBLE LP (For Single LPs): 1 x $20.99 = $_____ + 1 x $14.99 = $_____
Additional LPs:
___ x $20.99 = $_____ + ___ x $10.00 = $_____

TEE SHIRTS
ITEM QUANTITY SHIPPING
Price Total Price Total
SCM COVER TEE: 1 x $12.99 = $_____ + 1 x $9.49 = $_____
Additional TEE SHIRTs:
___ x $12.99 = $_____ + ___ x $3.00 = $_____
Sizes: S-M-L-XL-2XL (Please Circle Size)
SCM LOGO TEE: 1 x $12.99 = $_____ + 1 x $9.49 = $_____
Additional TEE SHIRTs:
___ x $12.99 = $_____ + ___ x $3.00 = $_____
Sizes: S-M-L-XL-2XL (Please Circle Size)

SPECIALLY PRICED BUNDLES
ITEM QUANTITY SHIPPING
Price Total Price Total
TEE SHIRT + CD: ___ x $19.99 = $_____ 1 x $9.49 = $____
TEE of Type: SCM COVER - SCM LOGO (Please Circle Size)
Sizes: S-M-L-XL-2XL (Please Circle Size)
Additional BUNDLES: ___ x $19.99 = $_____ __ x $3.00 = $____

ORDER TOTALS (Add totals from items above)
QUANTITY SHIPPING
TOTAL : $_____________ $_____________
GRAND TOTAL (Quantity + Shipping): $___________________