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(Please print this form fill it out and mail, FAX or e-mail it to us.) |
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| City:________________________________________ | State/Province:________________________________ | ||
| Country:_____________________________________ | Postal Code: _________________________________ | ||
| Telephone:___________________________________ | Email:_______________________________________ | ||
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The ladies addresses are $8.00 (US) each if you purchase from 2 to 4. (There is a minimum order of two addresses.) If you buy more than 5 but less than 10 addresses it is only $7.00 (US) each! And if you purchase more than 10 addresses they are only $6.00 (US) |
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| Order Total: |
| Method of Payment: Credit Card, Check or money order. Note: Customers outside of the USA are required to pay by Credit Card, International Money Order (Drawn on a US Bank) or Wire Transfer in US Dollars only (please e-mail for details). |
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Visa: MasterCard: American Express: Discover: Cash: Check: Money Order: |
| Credit Card # __________________________________ |
Expiration Date: MM / DD____/____ |
| Signature (Required):____________________________ |
Date: ___________ |
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Please make checks or money orders payable to ASL Corp. and mail it with this form to: |
| ASL Corp., PO Box 1555, Blue Hill, ME 04614 USA |
Telephone: 201-984-5020 |
Fax Number: 201-603-1133 |