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
F-T-]--_I I I I__FT-_ Expirationdace:r-'-]'_r-_
IMPORTANT: Copy complete account number from your MasterCard
IIII I[-T--r-N r-T-]---_ I I I I I
Cop5, Number above your name on MasterCard _ Expiration date: _
IMPORTANT:
FWFq-1 I
Expiration date:
Copy complete account nmnber from },our Discover Card
I I I II I I I IFI---I-_
AUTHORIZED SIGNATURE
Prices arc subject to change without notice.
Print or type your name and address
clearly. This will be your mailing label.
A complete and correct order will
save you days of waiting.
%..'.o'°;"-.4,.<. .7 4 :_ 7.:
Nallle:
Street:
City:
State:
Apt:
Zip:
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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