* Guitar Coach Fax/Postal Order Form *

Charanga Order Form

Fax Number +44 (0)1273 823 922

Products (Please enter quantity)	Electric Guitar Coach
	Guitar Coach
	KeyboardCoach

Title:
First Name:
Last Name:
Address:
Zip/Post Code:
Country:
Contact Phone Number:
Contact Fax Number:

Payment Method (Please Circle)

Credit Card - Debit Card - Cheque - Money Order

If paying by credit card please fill out the following details:
Credit Card: (please Circle)	VISA - MasterCard - Access - Eurocard - Delta - Electron - JCB
Card Number:
Expiry Date:

Please take the time to fill in the following optional details:

E-Mail Address:
Where did you hear about Charanga?

Signature:

Date: