NOTE: Dealers and Companies please provide dealer or company name, and also the name of the person to
whose attention the shipment should be sent.
S
Customer Name
H
I
Attention
P
T
Street address/P. O. BOX
O
City
Daytime Telephone Number
Check or money order enclosed payable to Helm Inc. U.S. funds only. Do not send cash.
Check here if your billing address is different from the shipping address shown above.
P
A
MasterCard
Y
M
Account Number
E
N
T
Security Code
Customer Signature
These Publications cannot be returned for credit without receiving advance authorization within 14 days of delivery. For returns, a
restocking fee may be applied against the original order.
HELM
P.O. BOX 07280, DETROIT, MICHIGAN 48207
260
Consumer Information
(
)
VISA
Apartment Number
State
Discover
Expiration: Mo. Yr.
Zip Code
Date