Order your CD today!

Please print this page and complete the form. Attach a check or money order made out to Darin Keech or fill in your credit card information and send to:

Band of Humans
5 Quaker Lane
Quaker HIll, CT 06375

Name_____________________________________________

Address____________________________________________

City_______________________State_______Zip___________

Phone_____________________Email________________________

Enclosed is my check for the CD, Alive I prefer to pay by Credit Card

Credit Card #: _______-_______-_______-_______

Expiration Date:_____-_____-_____

Authorized Signature______________________________

Number of CD's:______________

Multiply by:$15.00

Total Cost of CD's =______________ Shipping and Handling is included!!