Instructions: Please print and complete this form then mail or fax to: 785 783 3258 [Call Prior to Faxing]

Dust2Dust Music Network USA 4000 West 6th Street, Suite B 133 Lawrence, KS 66049

BOOKING CONFIRMATION FORM 

Business Name: ____________________________________________________

Your First and Last Names [Print]: ___________________________________________

Business Address: ___________________________________________________

E-mail Address: ___________________    

Contact Phone (s): Business:  __________________  Cell:  _____________________

Brief statement of terms offered [ie: amount to be paid, play order, deposit amount]: 

My deposit in the amount of $ _________ is enclosed. 

Please confirm ELCTRIKCHAIR at the above named venue for date: ______________

Peformance Time: _____________                  Load In Time: ___________

Your Signature: ___________________________

Title: ____________________________________

RETURN THIS FORM BY FAX.  REQUEST FAX NUMBER VIA E-MAIL AT:  www.ehunter1016@yahoo.com

***Contents of this form are legally protected and may not be reproduced, copied or duplicated in whole or in part without the written consent of Dust2Dust Music Network USA, violators of this provision are subject to civil prosecution for recovery of damages and financial losses including statutory penalties and attorneys fees as provided by law.