@ her Enf@rm @n
Charge 5,,our order on your VISA MasterCard,
or D scover Card by fill ng in below
USE YOUR CREDIT CARD
IMPORTAN r: Copy complete account number from you] V[SA card _/
I_,IPORTANT: Copy complete account number flora yore MastcrCa]d
CopyNumberaboveyournameonMasterCard _ Expiration date: [_] [_
IMPORTANT: Copy complete account numbe] from your Discover Card
Expiration date: [_ [_]
AUTHORIZED SIGNATURE
Prices are subject to change without notice
Print oi"type your name and
address clearly.
A complete and correct order will
save you days of waiting.
Namc:.
Address:
Apt:
City:
State: Zip:
E
Daytime Phone #: _12
¢)
Please make sure that both sides of this tbrm have been filied out completely. _
• Allow 4 weeks for delivery.
• All accessories are subject to availability.
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