DATE: _________________

NAME (Last): _____________________________ (First): ___________________________

SHIPPING TO: (Street): ___________________________________________________

(City): ____________________________________________________________________

(State/Nation): ___________________________________(ZIP/Postal Code):____________

Telephone: ___________________________ E-mail: _______________________________

NUMBER OF CDS ORDERED: GRANDPA FLATPICKED _____ ; REMEMBER ME _____ I WOULD DO IT ALL AGAIN _____ ROLL ON _____ TOTAL NUMBER OF CDs ORDERED: _____

TOTAL CD COST: Multiply TOTAL NUMBER OF CDs ORDERED by USD $15.00 $___________

SHIPPING/PACKING COST: USA, CANADA, MEXICO: First CD USD $3.00 then add USD $1.00 per additional CD. OTHER COUNTRIES:First CD USD $8.00 then add USD $2.00 per additonal CD: $ ___________

TOTAL COST: Add TOTAL CD COST plus SHIPPING PACKING COST $__________

THANKS VERY MUCH FOR YOUR ORDER!! Please remit in US Funds only by check or money order made to CHARLEY GROTH. Send to Charley Groth, c/o 1548 South Missouri Avenue # 115, Clearwater, Florida 33756 USA. Because Charley is on the road so much, please allow 6-8 weeks for delivery. E-mail Charley at charleygroth@yahoo.com for information on quantity discounts (holiday gifts, etcetera). Thanks again!!