Complete this order form, print it, and send it (with your check) to:

Lick Creek Band
3494 S County Road 250 E
Paoli IN 47454

Shipping information:

Name
Address
City
State
Zip
Phone

Please note: The form does not calculate totals. Please enter quantity and total due.

	Item	Price each	Quantity	Total Due
	Current	$15
	Live at the Old Hoosier Coffee House	$15
	Please have the band sign my CD (no charge).
	Please personalize my CD with the following text (no charge):
	Shipping & Handling
Total Due

If you would like to be added to Lick Creek's e-mail list, please add your e-mail address here:

Email

Please note: Lick Creek sends messages once or twice per month regarding performances and band news only. E-mail addresses are kept confidential.

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