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@_her
Enf@rm_@n
Charge your order on _our VISA MasterCard
or D scover Card by filling n below'
USE YOUR
CREDIT
CARD
IMPORTANT:
Copy complete account
numbm i_om your VISA card
_"
17777177717771777
E_,_,t,o_
d_o: r77 lED
IMPORTANT:
Copy complete account
numbm i?om your Master(aid
r7777 VTTT7 r7777 r7777
Copy Nmnber above your na ......
Master(aid
_
Expiration date: [77
[77
IMPORTANT:
Copy complete
account
number fi'om you," Discover
Card
1777717777
VT777177T1
Expiration date:
[77
[77
AUTHORIZED
SIGNATURE
Plices are subject to change without notice.
Print
or type your name
and
A complete
and correct
order
will
address
clearly,
save you days of waiting.
Name:
Street:
Apt:
City:
Stam:
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.
162
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