Name:
Address:
City:
State:		ZIP:
Phone:		E-mail:

Item Name or Number	Size	Price Each	Quantity	Total
Date of Order:			Total Due $

Please make checks or money orders payable to:  Bill Johnson
Charge cards accepted:  Visa and MasterCard
Credit Card #		Exp. Date:
Signature

• [  ] Check here if you wish item to be shipped to address other than indicated above  ... please write person's name and their shipping address on back of this form.
• We must include sales tax for California residents
• THANK YOU FOR YOUR ORDER!
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