Name____________________________________________________

Street Address____________________________________________

City________________________ State ___________ ZIP___________

Phone (Home )____________________Phone  (Cell)_____________________

Credit Card #______________________________________Exp Date________

I do hereby authorize Ed Roman to act as my agent and order for me the following special  merchandise.

Write in Item Desired Here______________________________________________________________________

I am aware that this item is NOT necessarily a stock item with Ed Roman.  I  hereby state that I will definitely NOT change my mind regarding this purchase.

I am fully aware that I am NOT entitled to any refund on this sale.  I realize that all new items sold by Ed Roman carry the full applicable mfr's warranty.  I realize that I am entitled to a full  warranty on any new item purchased.  I realize that with this agreement I am giving up my right to return this item. (except in cases where it has been pre discussed)

In cases of defect or problem, I realize that Ed Roman will act in my behalf  to return  item to the vendor. In the event that Ed Roman fails in their attempt to return the merchandise. I will not hold him or them responsible, nor will I bear him any ill will. 

In the unlikely event of a  price increase.   I realize that this is totally out of the control of  Ed Roman.  I agree to pay only the amount charged.  Ed Roman will not profit from increase.

I am also aware that all posted and quoted prices given by Ed Roman are cash sales, I am aware that by use of any credit card I may waive the right to claim any cash sale price.

I am aware that credit cards normally and legally charge merchants a fee to use their service.  I am also aware that the credit card companies levy still another fee on the merchant when and if a customer charge back occurs.  By signing this statement I certify that I will never attempt to charge back my credit card for any reason whatsoever.  I will bear all costs of collection and lawsuits on any chargeback on a credit card purchase no matter what circumstances prevail

I am aware that in cases of consignment or brokerage, Ed Roman is not responsible in any way for the product.  I have read and fully understand these terms.  I realize why these terms are imposed.

Signed X ________________________________________Date_____________
 

 The full price for the item $__________ 

Ed Roman ships instantly on Certified Checks, 

___I will mail you the balance by approximately this date_____/______/_____

___ I would like to pay the balance COD.

___ I will need Ed Roman to call me when it arrives to discuss balance.

___ Charge any balance to my credit card just before you ship

___ I don't have all the money now please put this item on layaway for me.     Please make all certified checks payable to "Ed Roman Guitars"