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NOTE: Dealers and Companies please provide dealer or company name, and also the name of the person to
whose attention the shipment should be sent.
AttentionCustomer Name
Apartment NumberStreet Address - No P. O. Box Number
Zip CodeStateCity
Daytime Telephone Number
Check or money order enclosed payable to Helm Inc.
U.S. funds only. Do not send cash.
MasterCard
VISA
Discover
DateCustomer Signature
These Publications cannot be returned for credit without receiving advance authorization within 14 days of delivery. On
returns, a restocking fee may be applied against the original order.
Check here if your billing address is different
from the shipping address shown above.
Expiration: Mo. Yr.Account Number
()
P.O. BOX 07280, DETROIT, MICHIGAN 48207
HELM
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Consumer Information
03/06/17 14:33:57 31GCF670_153
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