Charge your order on your VISA,MasterCard,
or Discover Card by filling in below
USE YOUR CREDIT CARD
IMPORTANT: Copy complete account number from your VISA card
I III II---l-Tql-l-Y-11--7-1--qExpirationdate:[-"r'-][--_
IMPORTANT: Copy complete account number from your MasterCard
l-_-T-ql I I I II I I I II I I I I
Copy Number above your name on MasterCard _ Expiration date: I
IMPORTANT: Copy complete account number from your Discover Card
I I I I II I I I II--FFNI I I I I
Expiration date: [--F-I
AUTHORIZED SIGNATURE
Prices are subject to change without notice.
Print or type your name and address
clearly.
Name:
Street:
City:
State:
IIIII
A complete and correct order will
save you days of waiting.
Apt:
Zip:
_l
Please make sure that both sides of this form have been filled out completely.
• Allow 4 weeks for delivery.
• All accessories are subject to availability.
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€.)
_D
_3
64
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