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ORDER
FORM FOR USMC Artist
Print and fill in the form below
(Please print clearly) |
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| Date: |
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| Name: |
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| Last |
First |
MI |
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| Address: |
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| City: |
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| State: |
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| Zip
code: |
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| Country: |
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| Telephone: |
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| Fax: |
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| E-Mail: |
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Pay
Method:
(Check one) |
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Check or Money Order enclosed
(make payable to Colonel Charles Waterhouse)
Visa Master Card |
Credit Card Info
| Card
Number: |
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| Expiration
date: |
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| Name
on Card: |
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| Signature: |
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Total
Amount of Order
| Total
from pages 2 - 4: |
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| New
Jersey Sales Tax (6%): |
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| Order
Total: |
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