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Instructions: Print this form out and check off each item you'd like to order. Make sure to specify quantity (especially if you're ordering more than one of any particular thing!).
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| YOUR INFORMATION |
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Name:__________________________________________________ Address:_____________________________________________________________
Phone No.:__________________________ |
| ROCTOBER MAGAZINE | ||
|---|---|---|
| Quantity | Item | Price |
| _____ | Roctober Subscription | $10 U.S. |
| _____ | Roctober #13 | $4 |
| _____ | Roctober #14 | $4 |
| _____ | Roctober #15 | $4 |
| _____ | Roctober #16 | $4 |
| _____ | Roctober #17 | $4 |
| _____ | Roctober #18 | $4 |
| _____ | Roctober #19 | $4 |
| _____ | Roctober #20 | $4 |
| _____ | Roctober #21 | $4 |
| _____ | Roctober #24 | $4 |
| _____ | Roctober #25 | $4 |
| _____ | Roctober #26 | $4 |
| _____ | Roctober #27 | $4 |
| _____ | Roctober #28 | $4 |
| _____ | Roctober #29 | $4 |
| _____ | Roctober #30 | $4 |
| _____ | Roctober #32 | $4 |
| _____ | Roctober #33 | $4 |
| _____ | Roctober #34 | $4 |
| _____ | Roctober #36 | $4 |
| _____ | Roctober #38 | $4 |
| _____ | Roctober #39 | $4 |
| _____ | Roctober #40 | $4 |
| Subtotal | _____ | |
| CHIC-A-GO-GO CD AND VIDEO | ||
|---|---|---|
| Quantity | Item | Price |
| _____ | Chic-A-Go-Go CD | One for$5, Three for $10 |
| _____ | Chic-A-Go-Go Video Subscription | 12 months (13 tapes): $120 |
| _____ | Chic-A-Go-Go Video Subscription | 6 months (6 tapes): $60 |
| _____ | Best of Chic-A-Go-Go Video | $15 |
| _____ | Chic-A-Go-Go 200th Episode Video | $10 |
| Subtotal | _____ | |
| GOBLINS MERCHANDISE | ||
|---|---|---|
| Quantity | Item | Price |
| _____ | "Missing Fits" Urn Set | $10 |
| _____ | The Goblins Tapes Microcassette | $6 |
| _____ | "Delilah's Theme" Flexi | $4 |
| _____ | "W-A-N-T-L-I-S-T" 7" | $4 |
| _____ | Goblin vs. Goblin 2x7" | $5 |
| _____ | Rocktoberfest 7" | $4 |
| _____ | Live at the Fireside Bowl 7" | $4 |
| _____ | Return of the Pharaohs VHS | $7 |
| _____ | KISSUE Release Party VHS | $5 |
| _____ | The Goblins and Friends! VHS | $5 |
| _____ | Instore VHS | $5 |
| Subtotal | _____ | |
| GRAND TOTAL | ______ |