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CREDIT CARD (MASTER CARD or VISA):
NUMBER:..................................................................
EXPIRATION DATE:.......................................................................
signature (for file).......................................................
email (for confirmation
of order) ........................................................ |
PERSONAL CHECK:
Make check payable to Kelly Mehler
NUMBER:..................................................................
DAYTIME PHONE:....................................................
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BILLING ADDRESS (for Credit
Card orders, if different from Shipping Address)
NAME...................................................................
ADDRESS..............................................................
.............................................................................
.............................................................................
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SHIPPING ADDRESS:
NAME...................................................................
ADDRESS..............................................................
.............................................................................
.............................................................................
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