I I I I I I I
NOTE: Dealers and Companies please provide dealer or company name. and also the
name of the person to whose attention the shipment should be sent. Mail completed order form to:
For purchases outside USA. please write to the above address for quotation.
HELM, INCORPORATED P.O. Box 07130 Detroit, MI 48207
(CUSTOMERS NAME) (ATTENTION)
(STREET ADDRESS-NO P.O. BOX NUMBERS)
(CITY) (STATE) (ZIP CODE)
..
DAYTIME TELEPHONE NO. 0
AREA CODE
MC-ORD98 *(Prices are subject to change without notice and without incurring
obligation. Allow ample time for delivery.) L
-
P
A
Y
M
E
N
T
-
Check or Money
Order payable
to Michigan Purchasers
TOTAL MATERIAL
Helm, Inc. (USA funds add 6% sales tax
only - do not send cash.)
0 Mastercard Canadian Postage
0 VISA
0 Discover
U.S. Order Processing
(See Note Below) $5.00
GRAND TOTAL
-
Account ml ml
Number:
Expiration m ml
Date mo/yr:
Check here if your billing address
is different from your shipping
address shown.
~
CUSTOMER SIGNATURE I ~ Note to Canadian Customers: All listed prices are quoted in US. funds. Canadian residents
are to make checks payable in US. funds. To cover Canadian postage, add $11.50 plus the US. order processing.
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