DR. CHUD MAIL ORDER
Print this form, fill it out and WRITE CLEARLY! - Include it with your order.
If you don't have a printer, hand write CLEARLY, all necessary info on a sheet of paper and include it with your order.

NAME: _________________________________________________________________________________

ADDRESS: ______________________________________________________________________________

CITY: ____________________________________________STATE: ________________________________

ZIP, POSTAL CODE: ____________________________COUNTRY_________________________________

E-MAIL ADDRESS: ________________________________________________________________________

MERCHANDISE
QTY OF: ____________Dr. Chuds X-Ward "Diagnosis for Death" Purple Vinyl........$20.00ea.= $___________
QTY OF: ____________Dr. Chuds X-Ward "Diagnosis for Death" Multimedia CD....$15.00ea.= $___________
QTY OF: ____________ Sacred Trash CD...........................................................................$15.00ea.= $___________
QTY OF: ____________ Sacred Trash Cassette..................................................................$15.00ea.= $___________
QTY OF: ____________Dr. Chuds X-Ward 07"Nurses and Curses" Tour Laminate...$15.00ea.= $___________
QTY OF: ____________Dr. Chuds X-Ward 06 "Mad Doc Tour" Tour Laminate.........$15.00ea.= $___________
QTY OF: ____________Dr. Chuds X-Ward 05 "Blood Drive" Part 1 Tour Laminate...$15.00ea.= $___________
QTY OF: ____________Dr. Chuds X-Ward 05 "Blood Drive"Part 2 Tour Laminate....$15.00ea.= $___________
QTY OF: ____________Dr. Chuds X-Ward BLACK Truckers hat, .........................$12.00 each....= $___________
QTY OF: ____________Dr. Chuds Deathguard Flag Pin, ..........................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds Cross Pin, .............................................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds Got Blood Pin, .....................................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds X-Ward Logo Pin, ..............................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds Diagnosis For Death Pin, ..................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds Dr.Pumpkin Pin, ..................................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds Headnurse Pin, ...................................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds X-Ward SERINGE PEN, ....................................$5.00 each....= $___________
QTY OF: ____________Dr. Chuds X-Ward LOGO Sticker, ......................................$2.00 each....= $___________
QTY OF: ____________DROSS LOGO Sticker, ..........................................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds CROSS Logo PATCH, .......................................$2.00 each....= $___________
QTY OF: ____________Dr. Chuds Deathguard Flag PATCH, .................................$2.00 each....= $___________
QTY OF: ____________2003 HALLOWEEN SHOW POSTER,...............................$25.00 each...= $___________
QTY OF: ____________2004 HALLOWEEN SHOW BL POSTER,.........................$25.00 each...= $___________
QTY OF: ____________Dr.Chuds X-Ward "MALPRACTICE" POSTER,...............$10.00 each ..= $___________
QTY OF: ____________Dr.Chuds X-Ward "04 Halloween Tour" BL POSTER.....$25.00 each ..= $___________
QTY OF: ____________2008 Dr. Chud autographed DRUMSTICK, ......................$10.00 each..= $___________
QTY & #: ___________________________Dr.Chuds X-Ward Guitar Picks,.......$2.00 each ..= $___________
QTY& SIZE OF: _________X____________Dr.Chuds X-Ward BABYDOLL......$15.00 each...=.$___________
QTY& SIZE OF: _________X____________X- LOGO T-Shirt,. .............................$15.00 each...=.$___________
QTY& SIZE OF: _________X____________Dr.Chuds X-Ward Logo T-Shirt,.....$20.00 each...=.$___________
QTY& SIZE OF: _________X____________Dr.Chuds X-Ward "Got Blood"T....$20.00 each...=.$___________
QTY& SIZE OF: _________X____________X-Ward Work Shirt,..........................$30.00 each...= $___________
QTY& SIZE OF: _________X____________X-Ward Hooded SweatShirt,...........$30.00 each...= $___________
QTY& SIZE OF: _________X____________2000 HALLOWEEN T-Shirt.............$20.00 each...=.$___________
QTY& SIZE OF: _________X____________2002 HALLOWEEN T-Shirt,............$20.00 each...=.$___________
QTY& SIZE OF: _________X____________2003 HALLOWEEN Tour Shirt,.......$25.00 each.. = $___________
QTY& SIZE OF: _________X____________2004 HALLOWEEN Tour Shirt,.......$25.00 each.. = $___________
QTY& SIZE OF: _________X____________2005 HALLOWEEN Tour Shirt........$25.00 each...=.$___________
QTY& SIZE OF: _________X____________2006 HALLOWEEN Tour Shirt........$25.00 each...=.$___________
QTY& SIZE OF: _________X____________2007 HALLOWEEN Tour Shirt........$25.00 each...=.$___________
SHIPPING AND HANDLING:
FREE SHIPPING ANYWHERE IN THE WORLD!!!

TOTAL # OF ITEMS ........................................................................____________
TOTAL PRICE OF SHIPPING..................................................... = --------FREE-------
TOTAL PRICE OF ITEMS........................................................... = $____________
GRAND TOTAL ENCLOSED...................................................... = $____________

All orders must be in the form of U.S. Money Orders or International Money Orders
or well conceled U.S. Cash or Cashiers Check..
NO PERSONAL CHECKS WILL BE ACCEPTED!
NO C.O.D'S, NO FOREIGN CHECKS!
Payment in full must accompany order.
Allow 3-6 weeks for delivery
SEND MONEY ORDER PAYABLE IN U.S. DOLLARS, MADE OUT TO CASH!
All money orders NOT made out to "Cash" will be sent back.

Mail To:
DRCHUD
P.O. Box 16,
Lodi, New Jersey
07644
U.S.A.
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