Hypnotic Clambake Mail Order Form

Please Print Neatly!

Full Name: _____________________________________________

Full Address: __________________________________________

Telephone: Day__________________ Evening__________________

E-Mail Address: ______________________________

Method of Payment: Postal Money Order ____ Personal Check ____

Merchandise Descriptions:
Square Dance Messiah CD ($12 ea.) Quantity_____
Gondola to Heaven CD ($12 ea.) Quantity SOLD OUT (available at CDBABY.COM)
Kent the Zen Master CD ($12 ea.) Quantity_____
Frozen Live CD ($12 ea.) Quantity_____
Varicose Brain CD ($15 ea.) Quantity_____
Mayonnaise CD ($15) Quantity_____

Live in Rutland Vermont-2 CD set ($18 ea.) Quantity_____
White Christmas Stallion CD ($4 ea.) Quantity ____
Past Lives Cassette (same songs as Square Dance Messiah CD, $7 ea.) Quantity____
General Turkey Cassette (same songs as Gondola to Heaven CD, $7 ea.) Quantity____
Arachnids Cassette (same songs as Kent the Zen Master CD, $7 ea.) Quantity____

For international please add $8.00 (Except Canada).

Sub-total: $
__________ Take off 10% for orders $40.00 and over! Sub-total after 10% discount $__________
Plus shipping. (1 unit, $4.00, 2 units, $4.00, 3 units $5.00, 4 units, $6.00, more than 5 add $0.50 for each unit)


Total Cost of Order: $__________

Please make all checks and money orders payable to:
MSR Management Inc.

Please mail this completed form along with your check or postal money order to:
Hypnotic Clambake
165 Sanford St.
Rochester, NY 14620