®
rr
s
TM
Charge your order on your VISA
or MasterCard by
filling in below
USE YOUR CREDIT CARD
IMPORTANT: Copy complete account number
from your VISA card
IMPORTANT: Copy complete account number
from your MasterCard
My card expires:
My card
expires:
Copy Number
above your
name on
MasterCard
AUTHORIZED SIGNATURE
Prices are subject to change without notice.
Name:
Street:
Apt:
City:
State:
Zip:
Print or type your name and
address clearly. This will be your
mailing label.
Please make sure that both sides of this form have
been filled out completely.
A complete and correct order will
save you days of waiting.
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