| Name | ____________________________________ |
| Company | ____________________________________ |
| Address | ____________________________________ |
| ____________________________________ | |
| City, State Zip | ____________________________________ |
| Phone#, Fax# | ____________________________________ |
| Item | Note | Price | Qty | Total Price |
|---|---|---|---|---|
| Book | $9.95 | __________ | ___________ | |
| Poster | Harley | $4.95 | __________ | ___________ |
| Poster | Book Front Cover | $4.95 | __________ | ___________ |
| Cassette Tapes | Set of Two | $11.95 | __________ | ___________ |
| Complete Set | $24.95 | __________ | ___________ | |
| Subtotal | ___________ | |||
| S&H | $3.00 | |||
| Grand Total | ___________ |
| Visa#, Exp. Date | ____________________________________ |
| Mastercard#, Exp. Date | ____________________________________ |