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P. O. BOX 07280, DETROIT, MICHIGAN 48207
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NOTE: Dealers and Companies please provide dealer or company name, and also the nameof theperson to
whose attention the shipment should be sent.
Customer Name
Attention
Street address/P. O. BOX Apartment Number
City State Zip Code
Daytime Telephone Number
Check ormoney orderenclosed payable to Helm Inc. U. S. funds only. Do not send cash.
Check hereif yourbilling addressis different fromthe shippingaddress shown above.
VISA DiscoverMasterCard
Account Number Expiration: Mo. Yr.
Customer Signature Date
These Publications cannot be returned for credit without receiving advanceauthorization within 14days ofdelivery. For
returns, arestocking fee may beapplied against the original order.
Security Code
()
HELM
272
Consumer Information
１０／０２／２５ １０：１０：５５ ３１ＨＮ２７００ ０２８１
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