2004 Top Fuel Dragsters Mail-In Order Form
Print Out - Fill Out - Mail In (US Funds Only)

Please send the following Top Fuel Dragsters:

• Send me ______ Books @ $29.95
• $ ____________ Total Cost of Books Ordered
• $ ____________ Shipping & Handling for each piece ordered ($5.00) -- (Canada $7.75) (Europe-UK $12.00)

Total: ________________

______________________________________________

Name: ___________________________________________________________

Company: ________________________________________________________

Shipping Address: __________________________________________________

City: _____________________________________________________________

State: _______________________________________ Zip Code: _____________

Mailing Address (if different): _________________________________________

Phone (Days): ____________________ Phone (Eves): ______________________

e-mail Address: ___________________________________________________

Special Instructions:________________________________________________

Select Payment Type: (include payment with form)

Check Payment Type: _____Cashiers _____ Money Order _____ Certified Check
_____ Personal Check
Check Number: __________ (personal checks need to clear our bank before order is shipped)

Make checks payable to: Howard Koby

Mail Order Form To:
Howard Koby
35ll W. 6th Street - Studio 19
Los Angeles, CA  90020

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