Name
Address
Address
City, State, Zip
Phone 1 Phone 2
E-mail address

Number of albums sent for transfer package: A B C

Number of tapes being sent: Reels Cassettes 8-tracks

Number of 78's being sent: Standard 78's Home Disc Recordings

Number of wire recordings being sent:

Other media not listed above:

Additional copies of CD's requested:

Please note on the back of this page, or on a separate sheet, any special instructions you'd like us to follow, what text you would like to have printed on the CD's, and so on. If you're sending collections of 45's or 78's, and want them in any particular order, just list the order and we'll follow it.

Is this a rush order? Yes No