Mouthpiece Order Form

IYM Corp.

38 E. Ridgewood Ave., Suite 257

Ridgewood, NJ 07450

(201) 652-6909

Mouthpiece Order Form (Effective Jan. 15, 2012)

Larry Kerchner Mellophone Mouthpiece - Model M-1 Quantity_______ @ $99 each

" " King, Jupiter Mellophone Mouthpiece - Model M-2 Quantity______ @ $99 each

Maximus Tuba Mouthpiece - Small receiver - Quantity _____________ @ $190 each

Maximus L Tuba - Large receiver - Quantity _____________________ @ $190 each

Maximus French Horn Mouthpiece - Quantity ____________________@ $75 each

Maximus E - Euphonium/Bass Trombone - Quantity _______________ @ $125 each

Maximus B-1 - Tenor Trombone/Baritone - Quantity ______________@ $115 each

Rudy Muck Trumpet Mouthpiece - Quantity ____________________ @ $ 80 each

Rudy Muck Tenor Trombone Mouthpiece - Quantity ______________ @ $99 each

Rudy Muck Tuba Mouthpiece - Quantity _______________________@ $150 each

All prices include shipping inside U S only. Questions for quantity pricing (4 or more) and shipping outside US can

be e-mailed to: Iymco@Aol.com.

Check or money order only - sorry no credit cards or COD - in US Funds drawn on a US Bank; payable to IYM Corp.

Shipping: Name _____________________________________________________________________________

Address____________________________________________________________________________________

City______________________________________________ State______________ Zip____________________

E-mail__________________________ Day phone____________________ Evening phone___________________

Mail Order Form and Payment to IYM Corp.; 38 E. Ridgewood Ave., Suite 257; Ridgewood, NJ 07450

IYM Corp. 38 E. Ridgewood Ave., Suite 257; Ridgewood, NJ 07450