Print this form, fill out completely, check your math, and mail to:

Alan Lathrem • 1750 W. Tangerine Rd., Tucson, AZ 85755 • USA

(Thank you for your order!)

PART #	DESCRIPTION	SIZE/TYPE/ COLOR/FORMAT (If required)	QTY	UNIT PRICE	TOTAL
SUBTOTAL:
Sales Tax:
Shipping: (Flat rate for continental U.S.A)				$ 8.95
Shipping: (Flat rate for outside of continental U.S.A)				$13.95
TOTAL REMITTANCE:

METHOD OF PAYMENT
[   ]	Check
[   ]	Credit Card:   [   ]  VISA    [   ]  Mastercard            Card No.:____________________  Expiration Date:______________            Signature:_______________________________________________
MAILING ADDRESS
	Name:__________________________________________________            Address:________________________________________________                          ________________________________________________                          ________________________________________________           Phone:_____________________ E-Mail:________________________________
COMMENTS / SPECIAL INSTRUCTIONS
	____________________________________________________________________  ____________________________________________________________________  ____________________________________________________________________  ____________________________________________________________________  ____________________________________________________________________  ____________________________________________________________________
If you have any questions, please call me (Linda Spencer) at: 315-689-3402

Print this form, fill out completely, check your math, and mail to:

Alan Lathrem • 1750 W. Tangerine Rd., Tucson, AZ 85755 • USA

(Thank you for your order!)