Mail to: Independent Records P.O. Box 510 Blairstown, NJ 07825

Bar Code Printable Registration Form

Personal Information

Name

Address

City State Zip

Phone Fax

E-mail Address Username

Purchase Information

Amount Item Price (each) Total

Single Format Label Registration $19.95 Two Format Label Registration $32.95 Three Plus Format Label Registration $44.95 Single Format Registration w/ Self-stick Labels $54.95 Two Format Registration w/ Self-stick Labels $104.95

Sub-total Shipping (USA only)

*Add $12.00 for standard mail shipping with label registration. **If you are ordering self-stick labels add $12.00 for shipping.

Total

Please send your money order (no personal checks please) made payable to Independent Records to:

Mail to: Independent Records P.O. Box 510 Blairstown, NJ 07825

Mail to: Independent Records P.O. Box 510 Blairstown, NJ 07825

Bar Code Printable Registration Form

Release Information Artist or Band Name

Release Title

Release Format(s): CD Cassette DVD VHS 7-Inch Vinyl

Shipping Method: Download Standard Shipping

Musical Style: (please choose one)

Blues Childrens Christian Classical Comedy Country Dance/Electric Gospel

Jazz Karaoke Latin Metal Movie Musical Performance New Age Rap

R&B Reggae Rock Ska Soundtrack Sports Others (Exercise, Documentary, etc)

NOTES Each bar code number is unique to each release title. A different number needs to be assigned to each title even if the band or artist stays the same. CD and cassette formats of the same release also have different bar code numbers from each other. The cost is $19.95 for each single format release. If releasing both CD and cassette of the same title, the price is $32.95 for the two format combinations. For three or more format combinations the price is $44.95. Bar codes sent using standard shipping are supplied on CD-R. Registration with self-stick labels are available for $54.95 for single registration or $104.95 for two registrations, plus $12.00 shipping.

For any questions, please refer to our privacy policy and terms of service or you may also contact us.