DAVID NELSON BAND
Freak Boutique Order Form

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Your Name
______________________________________________
Address
______________________________________________
City, State, Zip


What are you ordering?

        I T E M                      Ea    Qty
--------------------------------------------
Visions Under the Moon CD          | $15 |    |
Visions Under the Moon Cassette    | $10 |    |
Keeper of the Key CD               | $15 |    |
Limited Edition CD                 | $12 |    |	
High Adventure in Japan video      | $18 |    |
High Adventure in Japan CD Only    | $10 |    |  OUT OF STOCK  
Wires, Hearts & Magic video        | $18 |    |
Wires, Hearts & Magic/Visions pack | $25 |    |  SPECIAL OFFER!!!
Autographed Tour Poster            | $15 |    |
DNB baseball-type hat shield logo  | $20 |    | 
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                 SHIPPING TABLES

Please include the correct shipping charge with your order.


United States
Orders Between:  |    and     |  Pay     
                 |            | 
$0.00            | $20.00     | $3.00
$20.01           | $40.00     | $5.00
$40.01           | $60.00     | $6.00
$60.01           | $100.00    | $8.00
$100.01          | any amount | $10.00


International
Orders Between:  |    and     |  Pay     
                 |            | 
$0.00            | $20.00     | $13.00
$20.01           | $40.00     | $15.00
$40.01           | $60.00     | $16.00
$60.01           | $100.00    | $18.00
$100.01          | any amount | $20.00




SUBTOTAL __________________


SHIPPING __________________


TOTAL    __________________




Payment Method: Check __    Money Order __

Please allow up to 2 to 3 weeks for delivery.