PRINT OUT THIS FORM AND FAX TO BAREFOOTJERRY

Fill out this form and then
print it out on your computer to FAX TO BAREFOOTJERRY @ 615-612-2400

Mail Orders To:
Wayne Moss
1108 Cinderella Street
Madison, TN 37115
ALL INTERNET ORDERS ARE PERSONALLY AUTOGRAPHED UPON REQUEST!

Name:
Address:
Address:

City/State:
Zip:
Email:

I would like to purchase:

Area Code 615 Live $18	Quantity
New Hope Road $14	Quantity
Area Code 615 - A Trip In the Country 2 CD set. $25	Quantity
Southern Delights - Barefoot Jerry 2 CD set. $25	Quantity
Watchin' TV - Can't Get Off 2 CD set. $25	Quantity
Keys to the Country - Barefootin' 2 CD set.$25	Quantity
Barefoot 7$14	Quantity
Barefoot Live $18	Quantity

Would you like an autographed CD? Yes

Be sure to add $4 for postage.
Tennessee residents please add 8.25% sales tax.

TOTAL AMOUNT:

Checks or money orders only, please,
payable to Wayne Moss - Fax -615-612-2400