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NOTE: Dealers and Companies please provide dealer or company name, and also the name of the person to whose attention the
S
shipment should be sent.
H
I
Customer Name
P
Street address/P. O. BOX
T
City
O
Daytime Telephone Number
Check or money order enclosed payable to Helm Inc.
P
U.S. funds only. Do not send cash.
A
Y
MasterCard
M
VISA
E
N
Discover
T
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
250
Consumer Information
(
)
Account Number
Security Code
Attention
Apartment Number
State
Zip Code
Check here if your billing address is different from the
shipping address shown above.
Date
Expiration: Mo. Yr.

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