Name First:                      Last:              

Home Phone:                   Other Phone:   

Email Address: 

Mailing Address:    Street:        Apt.:   .

City:        State:         Zip:       

How Would You Prefer To Be Contacted?:   Choose One E-Mail Home Phone Other Phone Other      If Other: 

Strap Type:       Choose One Type I Type II Type III Other      If Other :   

Strap Design:    Choose One Plain With Name Only With Design Only With Name And Design With Full Design Other   If Other:   

Strap Color ( Main or Base Color ): Choose One Tan Med. Brown Drk. Brown Black Red Light Blue Dark Blue Light Green Dark Green Yellow Pink Turqoise Other If Other:   

Name or Lettering on Strap    

Letter Color:     Choose One Tan Med. Brown Drk. Brown Black Red Light Blue Dark Blue Light Green Dark Green Yellow Pink Turqoise Other If Other:      

Type of Design (Flowers, animals, symbols, etc.)    

Design Color:    Choose One Tan Med. Brown Drk. Brown Black Red Light Blue Dark Blue Light Green Dark Green Yellow Pink Turqoise Other If Other:

Type of Connection ( Front End) : Choose One Button Type Tie Strap Other If Other:

Type of Connection ( Back End):   Choose One Button Type Tie Strap Other If Other:

What Type of  Instrument do You Have?:  Choose One Acoustic Acoutic Electric Electric Bass Banjo Mandolin Dobro Other   If Other:

What Type of  Music do You Play Most?:  

What is your favorite color or colors?: 

Male or Female?:     Adult or Child?:  

Favorite Hobbies?:  

Where did you here about us?  

Any additional questions, comments, individual needs or concerns.

If you would like someone to contact you by phone for more information or to place your order, please list your contact phone and the most convenient time for us to call you below.

To help insure the privacy and confidentiality of the information provided. 

Please enter the following security code in the box below.

(Security Code Box)