Phonographs.org Antique Phonograph Repairs
John Nagy
8160 New Liberty Road
Maysville, IA 52773
USA

Please print clearly.

Date: ___________________________________________
Name: ___________________________________________
Street Address: ___________________________________________
City: ___________________________________________
State: ___________________________________________
Postal Code: ___________________________________________
Country: ___________________________________________
Email: ___________________________________________
Phone: ___________________________________________

All funds are in US Dollars (USD).

  Quantity Item Code Cost Each Line Total
Item #1        
Item #2        
Item #3        
Item #4        
Item #5        
Shipping Charges
Shipping Rate Sub-Total
$5.00 $0.00 - $14.99
$7.50 $15.00 - $29.99
$10.00 $30.00 - $59.99
$12.50 $60.00 - $89.99
$15.00 $90.00 and up
Shipping for larger/heavier items will be arranged separately. Contact [email protected] for a shipping quote.
Sub-Total:  
Tax (7%):
(IA residents only) 		 
Shipping:
(based on Sub-Total) 		 
Grand Total:  

You will be contacted by email regarding the shipment of this order.

Thank You!