Chicago Brass Works ORDER FORM NAME:____________________________________________________________ STREET ADDRESS_________________________________________________ CITY______________________________________________________________ STATE_________________ POSTAL CODE_________________________ COUNTRY__________________________________________________________ PHONE____________________________ EMAIL_________________________ I AM ORDERING THE FOLOWING: TSB RAW - $2,090.00 ____ TSB SILVER - $2,290.00 ____ TSB GOLD - $2,940.00 ____ TSC RAW - $2,230.00 ____ TSC SILVER - $2,430.00 ____ TSC GOLD - $3,080.00 ____ TSRH SILVER - $2,680.00____ TSRH GOLD - $3,300.00____ GSB RAW - $2,240.00 ____ GSB SILVER - $2,440.00 ____ GSB GOLD - $3090.00 ____ GSC RAW - $2,370.00 ____ GSC SILVER - $2,570.00 ____ GSC GOLD - $3,220.00 ____ TSBM SILVER - $2,540.00____ TSBM GOLD - $3,190.00____ I am paying by Check___ Visa____ Mastercard____ American Express____ Discover____ Credit Card Number_______________________________________Exp. Date_________Code________ Signature_____________________________________________________________________________ SHIPPING & INSURANCE ADD $37.00 per horn CONCIERGE SERVICE ADD $250.00 per horn TOTAL AMOUNT ENCLOSED: $_____________________ PLEASE MAKE CHECKS PAYABLE TO: Chicago Brass Works 101 North Hickory Aveune Arlington Heights, IL 60004 RETURN POLICY: 7 day trial from the date horn is received. Must be returned in original condition within 5 days of trial period Buyer will assume all shipping charges. A restocking fee may apply. NO RETURNS ON GOLD PLATED TRUMPETS