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PROV950H/pp. 058-061; 96/5/21/14:00
G.K. Associates, Tokyo
60
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TM
Charge your order on your VISA,
MasterCard, or Discover Card by
filling in below
USE YOUR CREDIT CARD
IMPORTANT: Copy complete account number
from your VISA card
IMPORTANT: Copy complete account number
from your MasterCard
My card expires:
My card
expires:
Copy Number
above your
name on
MasterCard
AUTHORIZED SIGNATURE
Prices are subject to change without notice.
Name:
Street:
Apt:
City:
State:
Zip:
Print or type your name and
address clearly. This will be
your mailing label.
Please make sure that both sides of this form
have been filled out completely.
• Allow 4 weeks for delivery.
• All accessories are subject to availability.
A complete and correct
order will save you days
of waiting.
IMPORTANT: Copy complete account number
from your Discover Card
My card expires:
Accessory Order Form