Van Cott Information Services, Inc.

Secure Order Form

STOP! Unless we have sent you to this page to enter a credit card or you can't get the shopping cart to work, back up to the previous page and select Start Checkout at the top of the page.

Please check your email within 48 hours of submitting this order. If we have any questions
on your order we will email them to you. THIS IS ESPECIALLY IMPORTANT FOR FOREIGN ORDERS!
If you do not hear from us in 48 hours we probably did not get your order or
were unable to reach you via email. Please try contacting us again.

Name               Email Address      Day Phone          Evening Phone      Billing Address (for your credit card -- if you are a college student away from home this may not be the same as your current mailing address)                    Shipping Address      Use Billing Address                    Order Details (Unless you are responding to our request for another credit card, you must enter what you want in this box, please use our shopping cart instead, if possible.)                    Shipping          Media Mail (book rate-US) Priority (US) International Air Mail Insurance          No Insurance Insurance Credit Card Type          Visa MasterCard Discover American Express Credit Card #     Expiration Date (mm/yy) Enter credit card code* here:

*Visa, MasterCard, and Discover: The code is 3 digits following your card # on the back of your card in the space where you sign your name.

*American Express: The 4 digit code is printed on the front of the card above and near the end of your credit card #.

Interest(s):  Bassoon  Clarinet  Flute  Oboe  Saxophone           Horn  Trombone  Trumpet  Tuba  Other (please specifiy in comments)

Comments/Special Instructions


Van Cott Information Services, Inc.
P.O. Box 9569
Las Vegas, NV 89191, USA
Phone: 702-438-2102 Fax: 801-650-1719
Email: info@vcisinc.com