For More Information: Hudson Valley Records P.O. Box 510 Carmel, NY 10512 Toll Free: 866-HVR-SONG (487-7664) Local: 845-225-6666 fax: 845-225-4729 hudsonvalley@earthlink.net Visit our other web site at: hudsonvalleyrecords.com

S E C U R E   O R D E R   F O R M To order your favorite ScooterWare items, select the item, image name, size, color & quantity of items you want. Then print and complete the form below and either: Fax it to: 845-225-4729   OR Mail it to: Hudson Valley Records, P.O. Box 510, Carmel, NY 10512   OR Call us toll free at 1-866-HVR-SONG (487-7664). (For orders shipping outside of the U.S., please call us.) Please indicate if you have any specific deadline for your order - we will contact you to discuss alternate selections if we anticipate any problems in filling your order in time Payment Information: Name on Credit Card: ______________________ Charge to: Visa ___ Mastercard ___ AmExp ___ Discover ___ Card #: ___________________ Exp. Date: (mm/yy) _____ Check Enclosed: ____   Money Order Enclosed: ____ (Make Checks/Money Orders out to "Hudson Valley Records") Signature (for charge orders):______________________________ Billing Information: Name: ___________________________________________ Address: _________________________________________ City: ____________________________________________ State: _______   Zip: ___________   Country: ____________ Daytime Phone: ___________ Evening Phone: ____________ Email Address: ________________________ Specific Deadline, if any: _____________ Shipping Information: (If different than billing information) - Please indicate gift deadlines! Name: _____________________________ (Occasion/Deadline): ________________ Address: _________________________________________ City: ____________________________________________ State: _______   Zip: ___________   Country: ____________ Daytime Phone: ___________ Evening Phone: ____________ Order Form: * The first line is an example of how to complete the order form: Description Image Size Color Qty. Price Each Total Price T-Shirt Rock XL Cream 2 $12.95 $25.90                                                                                                   Total Merchandise       Shipping/Handling ($2.00 for each item ordered)       SUB TOTAL       Sales Tax NY Residents only add appropriate %       TOTAL AMOUNT