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
__1 I [ 11 [ I [ Expirationdate:["'-_'-"]
IMPORTANT: Copy complete account number from your MasterCard
7T7- -5-Y-q VT-l-q-qV-VTS-q
Copy Number above your name on MasterCard _ Expiration date: [--T"]
IMPORTANT: Copy complete account number from your Discover Card
I I I I I VTq-_ [-I-T_ [-q-]-_
Expiration date: _ ['_
AUTHORIZED SIGNATURE
Prices are 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.
Name:
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.
7O
€
