Webmistris MUSIC CODE and HELP

ORDER FORM

(You may find this form easier, you can print it out and send it to the address below)

First Name (optional) Last Name (optional)

MEMBER Name (required)

Password (if required)

Please mark [X] for your choice of service

BACKGROUNDS [ ]

MUSIC CODE AND REQUESTS [ ]

Do you have your own web space? [ ]Y [ ] N - If Yes, can you upload the files to your space? [ ] Y [ ] N

What Option # do you want? _________ If it is a FREE background, what is the background # ________

What is your song request and artist name?__________________________________________________

Do you have a second song request? ________________________________________________________

Amount of donation sent:$_________

Can you put the code on your page, if I email it to you? - [ ] Y [ ] N (Add $2.00 and I'll do it for you , remember to include your password ______________________)

Please send my background or MUSIC CODE and/or files to : Email address: ______________________

If I am putting the code on for you and the file is on my web space do you want a copy of the file sent to your email address along with the html code anyway? [ ]Y - [ ] N - [ ] I don't care

Additional comments or instructions:

http://members.blackplanet.com/webmistris/

Please send this form and a money order (check or cash) to

Patricia Wyatt

P O Box 3783

Kansas City, KS 66103

THANK YOU!