Please make Checks and Money Orders
payable to:(If possible print this form and include with your order.) RPJ and mail to: RPJ * P.O. Box 931754 * Los Angeles, CA 90046 |
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Billing Address: |
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Address: |
____________________________________ | (* Shipping and
Tax included!) |
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Shipping Address: |
If different from Billing Address! | ||
Name: |
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Address: |
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Credit Card: |
Visa Master Card American Express | ||
Credit Card Number: |
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Exp. Date: |
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I
hereby certify that I am over the age off 18 years. |
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Signature: |
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Date: |
<% = Date%> | ||
Please contact us via e-mail
rpj1510@hotmail.com |
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