H o m e | P u n c h e s | P e n s | A l b u m s | O r d e r i n g

Make Check/Money Order Payable to:
H. A. THROWER
4619 E. LINCOLN AVE
HEMET, CA 92544
O R D E R F O R M - (Order Form Will Print as Two Pages) 
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              SHIPPING ADDRESS         |     INDICATE TYPE PAYMENT
                                       | 
NAME:  _______________________________ | 
                                       |
STREET:_______________________________ |______Check  ______Money Order 
                                       | 
       __________________Apt. No._____ |
                                       |Amount $_____________ 
CITY:  _______________________________ |
                                       | 
STATE: ___________________ZIP:________ |Signature:_______________________ 
                                       |
E-Mail:_______________________________ |
_______________________________________|__________________________________
  ITEM  |   DESCRIPTION    |    QTY.   |       UNIT       |      TOTAL
   NO.  |                  |           |       PRICE      |      PRICE
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 Please add the following shipping $ handling:     |
                                                   |        
 Shipping and Handling Charge is $5.00             |  SUB TOTAL:
                                                   |  ______________________
 Regardless of Size of Order.                      |                                                                                                              
                                                   | California Residents        
                                                   | Please Add 7.50% 
                                                   | Sales TAX _____________
                                                   |  
                                                   | Shipping and Handling
                                                   |  ________$5.00_________
                                                   |            
                                                   | Total Due:
                                                      ______________________