ORDER FORM FOR "WOMAN IN LOVE"--YUKO UEYAMA

Please fill out this form, submit it, then print out your e-mail confirmation receipt and send it with your cashier's check or money order to:

Yuko Ueyama
yukoueyama.com
3-14-6-102 Narusegaoka
Machida-shi, Tokyo 194 JAPAN

OR: You may simply print out the form from your browser and mail it with your payment to the address previously listed above.
Orders will be shipped and process within 3-4 weeks after payment has been received. Some orders may take longer due to international shipping. Sorry, no personal checks please! If you decide to use your option to submit this form, we will be able to process your order more quickly. We thank you for your support! Enjoy!

*Full Name:

*Street Address:

*City:

*ST/Province:

*ZIP/Postal Code:

*Country:

Phone Number:

*E-Mail:

Shipping Address
If different
from Billing
Address

Select Your Order:
Quantity    Product Description

    CD: "Woman In Love" - $24.95 ($19.95 + $5.00 P&H - USA)
     CD: "Woman In Love" - Ľ2800 Yen (JAPAN)
     Single: "Daiya No Yubiwa" w/ "Gimme A Chance" - $9.75 ($6.75 + $3.00 P&H - USA)
     Single: "Daiya No Yubiwa" w/ "Gimme A Chance" - Ľ1000 Yen (JAPAN)
     Both Album CD & Single CD - $34.70 ($26.70+ $8.00 P&H - USA)
     Both Album CD & Single CD - Ľ3800 Yen (JAPAN)

Payment Method:

Comments

Please do not double-click the Submit button!