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NOTE: Dealers and Companies pleaseprovide dealer orcompany name, and also the name ofthe person to
whose attention the shipment should be sent.
Daytime Telephone Number
City
Street address/P. O. BOX
State Zip Code
Apartment Number
Attention
Customer Name
Customer Signature Date
Check ormoney order enclosed payable toHelm Inc. U.S. funds only. Do not send cash.
Check hereif your billing address is different from the shipping address shown above.
MasterCard
Account Number
VISA Discover
Expiration: Mo. Yr.
These Publications cannot be returnedfor credit without receiving advance authorization within 14 days of delivery. For returns, a
restocking fee may be applied against theoriginal order.
Security Code
()
P.O. BOX 07280, DETROIT, MICHIGAN 48207
HELM
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260
Consumer Information
０８／１１／２１ １１：０９：４３ ３１ＭＣＡ６９０ ０２６７
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