ORDER FORM

Print this form with your web browser, then fax to 775-521-7001 fax or
or mail to: Danny Black, 208B S 8TH ST, LANSING MI 48912-1422 USA
or submit using the recently enabled secure PayPal shopping cart buttons
Send Check or Money Order in U.S. FUNDS PAYABLE TO: DANNY BLACK
Regrets no COD delivery
Allow 1-2 weeks delivery in Continental US, & 6-8 weeks delivery outside US
Prices subject to change. Please provide credit card billing & shipping address

dwarf beta tester @ $16.99 USD plus USA shipping x # ___ = $_____


dwarf beta tester @ $16.99 USD plus OUTSIDE USA shipping x # ___ = $_____
our regrets, OUTSIDE USA payment not possible with PayPal

MERCHANDISE TOTAL minimum order $ 9.99 $_____

SHIPPING US per order $5.00 Outside US $7.00 $_____

TOTAL ENCLOSED Payable to Danny Black $_____

CREDIT CARD NO. (Visa, Mastercard, Discover or American Express ONLY)

card number __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

expiration date __ __ - __ __

signature of authorized buyer__________________________________________
I AGREE TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT

NAME __________________________________________

credit card billing ADDRESS __________________________________________
(UPS will not deliver to P. O. Boxes)

CITY STATE ZIP __________________________________________

COUNTRY __________________________________________

PHONE __________________________________________
(so that we may contact you in the event we have a question about your order)

and/or FAX or E-MAIL ADDRESS __________________________________________
(with orders outside continental US in the event we have a question about your order)