Print and Mail to:
EZWINR
PO Box 1537
Sierra Madre, CA 91025
Make checks payable to EZWINR
All prices include shipping
Name:________________________________________________________________
Address:_____________________________________________________________
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City:_____________________Province/State:_________Postal Code:_______
Daytime Telephone Number: (_______)__________________________________
E-Mail Address:______________________________________________________
Item Unit Total
Quantity Description Price Price
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Merchandise Total ______________
Californian Customers add 8/4% Sales Tax ______________
TOTAL___________
SIGNING INSTRUCTIONS:
(Please indicate to whom Gary should sign the item)
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