INTERNATIONAL PIANO SUPPLY
~Order Form~

After printing this page, complete and snail-mail, email, phone or fax your order to us at:
IPS - 88 NewOctave Loop, P.O. Box 1005 - Astoria, OR 97103-1005 - USA
Order Placement: 1-503-325-0555
24 Hour Fax: 1-503-325-0860
Email: ips@pianosupply.com

PLEASE PRINT CLEARLY
Name:______________________________________________________

Shipping Address:___________________________________________________

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City:_____________________________State/Province:_____Country:_____________

Postal Code:__________

Phone:_____________________________________________________

Email Address:___________________________________________

Credit Card #:_______ _______ _______ _________Expiration________

CVV (3-digit # on the back of your card on the signature line)___________

Credit card billing address (if different than above)

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Item # |Quantity|       Description     |Unit Price|  Total 

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If ordering more items than space allows on this page, please print 
additional forms.  

Check here____ to indicate your acceptance of our Terms of Sale.

Thank you for your order with us.