Name______________________________________________________

Address____________________________________________________

        ____________________________________________________

City ST___________________________________ Country (if not US) ____________________

Zip or Postal Code_______________________

Day Phone________________________  Evening Phone _________________________________

E-mail _________________________________________________

_Qty_____Description__________________________________Price______________Total______                                                
|      | Deluxe Hammered Dulcimer                    | $950.00         |            |                                        
|______|_____________________________________________|_________________|____________|
| Wood choice for rails|                   |Wood choice for Soundboard |            |                                        
|______________________|___________________|___________________________|____________|                                                                               
| Bass tuning  [Octave(Michigan)][Standard (fifth)]  |Custom sound hole|            |   
|____________________________________________________|_________________|____________|
|      | Protege Hammered Dulcimer                   | $650.00         |            |                                        
|______|_____________________________________________|_________________|____________|
|      | Folding Hammered Dulcimer Stand             |  $75.00         |            |                                        
|______|_____________________________________________|_________________|____________|
|      | Hammers [Unpadded][Padded]                  |  $35.00 per pair|            |                                        
|______|_____________________________________________|_________________|____________|
|      | Korg Electronic tuners [AT 2 $85][CA20 $19] |                 |            |                                        
|______|_____________________________________________|_________________|____________|
|      | Other items                                 |                 |            |                                        
|______|_____________________________________________|_________________|____________|
|      |                                             |                 |            |                                        
|______|_____________________________________________|_________________|____________|
Please note:  A stand and one pair of hammers are                      |            |
included in the price of the hammered dulcimers.              Sub total|____________|
Wood choices and soundhole options are not                             |            |
available in the protege.                           Colo res add 3% Tax|____________|
                                                                       |            |             
Shipping costs on hammered dulcimers are around $30           Shipping |____________|
We will charge exactly what UPS charges us. If you                     |            |
need to know exact shipping charges in advance please       Grand Total|____________|
call or e-mail.

Method of payment:___Check or money order ____ Credit Card (MasterCard, Visa, Discover)

Card # |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__| Exp |__|__/__|__|

Name as it appears on card, if different from above_____________________________