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_ccessory Order Form ...........................
i
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
Iill iI-r-l-ql--I- I-7
Mycar_expires:I-'T--I
IMPORTANT: Copy complete account number
from your MasterCard
I I I I I[ I II II I I I IIT-IW-]
CopyN.mber [ I [ 1 I My card [7"7 [_]
above your expires:
name on
MasterCard
IMPORTANT: Copy complete account number
from your Discover Card
I1IIIIIIIIIIIIIIIIII
Mycardexpiros:i--rq7-l-q
AUTHORIZED SIGNATURE
Prices are subject to change without notice.
Print or type your name and
address clearly. This will be
your mailing label.
Acomplete 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.
_7
52
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