----------------------------------------------------------------------------------------------------- FAX this form to 1-267-543-4908 Enclosed is my check, money order or credit card order for $_____________.00 plus $7 S&H ($17 foreign orders) Totaling $_____________.00 Charge my (Note: You can use more than one card to complete this order): Visa, Mastercard Card Number:_____________________________________________ Exp. Date:______________ Signature: __________________________________________ Print Name: _______________________________________________________________________ Address 1: _________________________________________________________________________ Address 2: _________________________________________________________________________ City: ______________________________________ State: __________________________________ Zip Code: ______________________________ Country: __________________________________ Date of Birth: _____________________________________ Job Occupation (or former occupation) _______________________________ Telephone: _______________________________________________ Fax Number: _____________________________________________ E-Mail: __________________________________________________
Or Mail This Order Form To: Palko Publishing All sales are final. There are no refunds, exhanges or any reimbursements.
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