First Name: (John)

Last Name: (Smith)

Address 1: (8163 Lankershim Blvd.)

Address 2: (Suite #206)

City: (North Hollywood)

State: (CA)

Zip: (91605)

Phone: ((800) 555-1212)

E-mail: (user@domain.tld)

Age: (24)

Sex: (Male)
Male | Female

1. Name one of your favorite bands or artists:

2. Name one of your favorite websites:

3. Name one of your favorite magazines:

4. If you currently own a guitar, bass, or amp, please list the types and brands below:

5. Where did you learn of Fernandes Guitars?
Guitar World
Guitar One
Hit Parader
www.FernandesGuitars.com
Other (please sepecify):

6. How long have you been playing ...
Guitar: Bass: