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P. O. BOX 07280, DETROIT, MICHIGAN 48207
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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
Street address/P. O. BOX Apartment Number
City State Zip Code
Daytime Telephone Number
Check or money order enclosed payable to Helm Inc. U. S. funds only. Do not send cash.
Check here if your billing address is different from the shipping address shown above.
VISA DiscoverMasterCard
Expiration: Mo. Yr.
Customer Signature Date
These Publications cannot be returned for credit without receiving advance authorization within 14 days of delivery. For
returns, a restocking fee may be applied against the original order.
Account Number
Security Code
()
HELM
226
Consumer Information
０９／０５／１１ １５：１６：５１ ３１ＨＰ４８３０ ０２３５
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