E-Mail Address: 
* Mr.  Mrs.  Ms.

* First Name: 
  Initial:    
* Last Name:  


* Age:  


* Address: 
           
* City:    
* State:   
* Zip:     

* Phone: ()-

* Please select musical preference.

 Light Sounds       Jazz
 Country            Metal
 Hard Rock          R&B
 Soft Rock          Alternative
 Classical          Rap/Hip Hop
 Dance/Pop          Christian/Gospel
 Easy Listening     Latin

* Send my selections on
CDs
Cassettes


Please select CDs before submiting application.
(write down catalog #'s and enter them below)
NOTE: Make sure that the catalog #'s are from COLUMBIA HOUSE.
Any applications using catalog #'s from CD Universe or BMG will be rejected
* Selections: NOTE 2CD SET counts as 2 Single CDs
   
   
  

(OPTIONAL) Bonus Offer from me:  In addition to your 11 free from CH,
                                 I will send you an additional CD for
                                 $3.00 (to cover my shipping costs).
Click here for the payment option on this CD.
CD #     CD Name: 

(OPTIONAL) Bonus Offer from CH:
Send another selection for $6.98 + shipping/tax & a FREE selection.
($6.98 additional enrollment charge)
 

  Do you have a telephone?                      Yes   No 
* Have you been a Columbia House Member before? Yes   No 
  Have you ever bought anything by mail before? Yes   No 
  How have you paid for your mail-order puchase? (check all that apply)
   Cash
   Credit Card
   Check
   Money Order

*  I have read the discliamer.
     Also, the above information is correct to the best of my knowledge.

*  I reside in the Continental United States.
     Sorry, not available in APO, FPO, Alaska, Hawaii, Puerto Rico, & Canada.

*  I have read the payment agreement.
     I also understand that IF I have requested a 12th CD, that it will
     be sent AFTER I have paid for my first 11 CDs.
     (Shipping is $2.39 per CD plus tax, if applicable)

 Press Once, and wait for the next screen.