DMA Trophy Order Form

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2002 DETROIT MUSIC AWARDS

Additional Trophy Order Form

ORDERS MUST BE RECEIVED BY JUNE 4, 2002

Please print or type:

Award category as it appears on award name plate:

______________________________________________

Name of individual or group as it appears on award name plate:

______________________________________________

Shipping Information:

Name__________________________________________________________

Address________________________________________________________

Phone_________________________________________________________

E-Mail________________________________________________________

Award	$ 33.00		Order Qty.______
Tax:	1.92
Shipping	5.00
Total	$ 39.92	/ea

Please send check or money order to:

The Reliance Group

23937 Freeway Park Drive

Farmington Hills, MI 48335