Name_____________________________            If shipping to a different
                                                                            Address, please check here Street______________________________     and write on reverse side___

City________________________________State___________Zip___________

Phone_________________Email__________________@____________
       Model of Stand (please check)
____Victorian Lyre($385) __Solid Back($345)__Conductor Solid Back 14"x24"($355)
___Classical  Lyre ($375) __ Column ($345)  ___Conductor Lyre Pattern ($415)
___Bird of Paradise ($385)   __Church Logo Inlay UMC/Presby 13 x 22"    $ (375)
___Tulip Lyre with lyre($375) ____Cross Inlay ($355) 12"x 22"
___Tulip Lyre with Instrument($385)  What instrument or initial inside Tulip Lyre __________
___  Desk / Stationary Stand ($195) __Double back music storage stand ($450)
____  Zither ($365)   ____Art Deco Stand ($375.00)  ____Duet Stand ($495)
____ Modern Classic  (355.00) ___ Diamond Jim ( 375.00) ____ Staffer ( 375.00)
____Victorian Lyre with design ($395-) what design ? initial,  harp, cross, violin etc... _____________
____  Stand style not listed above____________________or write on back side of form
 Type of wood (circle)  Oak    Mahogany    Alder     Maple    Cherry
  Its a good idea to send a picture of the color stand you want from the web site
  other__ (usually a $ 40 - 75 .00 extra charge for exotic woods like Birdseye, Curley Cherry, walnut
___  Match my furniture ( I'll send you some photos or a picture of a stand from the web site)
 Stain color-circle Red Mahogany     Early American  __   You can Print a picture of
                            Aged cherry stain ( like a old violin)   Other______  a stand from the web site of
____Mix the woods ( no Charge - List woods ) _________________ the color you would like
 ____Extra Storage Shelf ($65) -stores bow,tuners, pencils,tuning keys,rosin,business cards,)
____ check here for notched ends for bow storage on Extra Shelf ____ Music Stand Light ( 35.00)
 ____   Sheet Music Storage Tray  ($85) ( sits down below music tray & stores sheet music)
 ____Brass accents ($35) Brass accents include brass knobs,  brass corner pcs. on lower mid
                              section ,  bronze knobs do look better on some colors .
____Brass, bronze, black knobs only  ($20)   Brass Plaque ($15-write wording on reverse side)
____ Standard Wooden knobs stained to match ( no charge) ____ Music Stand carrying bag $95.00
       Other Instructions (please write on the back if you need more room)
Are we matching anything in particular?_______________Furniture, instrument ?
Is this a surprise for someone?_____If so, how do we contact you without
spoiling the surprise?_______________________________________________
***What type of instrument is this for-violin,cello,harp,voice,choir dir, book stand ? ___
What is the height of your stand now?______(Standard height is 30" - 50" Measured from floor to music tray)
Do you need this for a specific date?________   When?________
Return to:
Mister Standman Music Stands        208-664-4321
6692 E. French Gulch Rd               misterstandman@earthlink.net
Coeur d'Alene, ID 83814                 www.misterstandman.com