Title		First		Last
Street				Street 2
City				State
Postal Code				Country
Home Phone				Cell Phone
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Please check item(s) desired and indicate choices when appropriate.
	Separate Footjoint
Model	C footjoint B footjoint D footjoint
Material	Sterling silver 10K gold/silver 14K gold/silver other
Case	Single flute Combination (flute and piccolo) Headjoint Other
Case Cover	Single flute Combination
	Key Extensions
Please check items	Complete Set C# (plastic) Silver G# extension Finger Buttons (check number desired) A1 A2 B1 B2 C1 C2
The key extensions are for	A new Brannen-Cooper flute being ordered Brannen-Cooper flute, serial # The following type of non-Brannen flute
	Flute Cleaning Rod
	Flute Polishing Cloth