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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.
Customer Name Attention
Zip CodeStateCity
Daytime Telephone Number
Check here if your billing address is different from the
shipping address shown above.
Check or money order enclosed payable to Helm Inc.
U.S. funds only. Do not send cash.
MasterCard
VISA
Discover
Account Number
Date
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.
Expiration: Mo. Yr.
Customer Signature
Apartment NumberStreet Address - No P. O. Box Number
()
P.O. BOX 07280, DETROIT, MICHIGAN 48207
HELM
P
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S
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Consumer Information
04/10/19 11:04:31 31KSZ610_211
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