Charge your order on your VISA
or MasterCard by
filline in below
USE YOUR CREDIT CARD
IMPORTANT: Copy complete account number
from your VISA card
IMPORTANT: Copy complete
account
number
from your Mastercard
Copy Number
above
YOUI
name on
MasterCard
AUTHORIZED SIGNATURE
Prices are subject to change without notice.
L
print or type your name and
address clearly. ‘Ibis will be
mailing label.
your
A complete and correct order will
save you days of waiting.
r---------------------------
I
1 Name:
I
I
1 Street:
I
I
Apt:
I
I
I
City:
I
I
I
t
State:
Zip:
I
I
----______-----------------
A
Please make sure that both
sides of
this
form
have
been filled
out completely.
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