Mail in Order Form

Please print and mail the completed form with $5.00 for shipping and handling to:
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Robert Nelsen
P.O. Box 493669
Redding, CA 96049-3669


SHIPPING & HANDLING $5.00

Check Enclosed (Please make payable to Robert Nelsen)
VISA or MasterCard
I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I exp.___/___

PLEASE RUSH MY ORDER TO:

Your Name:________________________________________________________________________

Address:__________________________________________________________________________

City: _____________________________________________ State: _________ Zip: _____________

E-mail Address: __________________________________
(required)

Telephone: ( ______ ) __________________________



Signed: __________________________________
Date: __________________________________


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