| Name |
_________________________________
| | Address |
_________________________________
_________________________________
_________________________________
_________________________________
| | No. of copies
|
_________________________________
|
|
Optional
| Phone |
_________________________________
| | Fax |
_________________________________
| | EMail |
_________________________________
| |
How did you hear about Boat Docking?
|
_________________________________
_________________________________
_________________________________
| |
Personalized inscription?
|
_________________________________
|
|
Please include a check or money order for $15.95 U.S. [$17.95 CDN, other countries please inquire], made out to Harvey Island Enterprises, or use your VISA.
Delivery times to the U.S. vary - often three weeks.
|
|
number: _________________________
exp. date (mm/yy): __/__
| | Signature
|
_________________________________
| | Name on VISA card
|
_________________________________
|
|