The Banjo Loft

Order Form

Date:_____/_____/_____

Wyatt C Fawley

P.O.Box 253

Greensboro, Pa 15338

724-943-4581

Billing Address:

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Item #	Item	Description	Price	Qty	Total

Shipping Charges  USPS  Method Only			Sub-Total	______
Instruments- 75.00			Shipping	______
Necks or Resonators 25.00		Pa Residents Only	6% Sales Tax	______
Outside the Continental USA - inquire			Total	______

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Thank-you for your order!