Submit Your YearEnder List! - Pure Pop Records

Request Form

Please use the form below to request a purchase either through paypal, over the phone or in-store pickup. We'll contact you right back and let you know the status and price.

Name
First Last
Email*
Enter Email Confirm Email

please confirm that your email address is the address associated w/ your paypal account if paypal purchase is requested.
Artist / Album*

Please type the artist and album
Format*
Payment/Delivery method*
Choose your method of payment and how you want to get your hands on the requested item(s)
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Questions / Comments
Please include any other useful info, questions or comments.
Comments
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Tickets at Pure Pop

Request Form