New Customer Info Sheet
We will get back to you about whether you want a paper catalog. Unfortunately, they cost us, so we can't mail them out for free.
Don't worry, you can still order all you want without one.
Name:
Phone Number:
Address:
Acme Rocket Skates Attn:John Doe 123 Mystreet Anytown, USA 12345
What is your business?
Jukebox Route
Box in your location
Home Jukebox
45's for another purpose
Other
What music is most useful to you?
Pop
Country
Hard Rock
Club/Mix
R&B
Rap
Oldies
Adult Contemporary
Album/Classic Rock
A little note to the staff: