YOU MAY PRINT OUT THIS ORDER FORM AND RETURN WITH EITHER CHECK OR CREDIT CARD INFO FOR $26.70

PLEASE MAIL TO THE ADDRESS AT THE BOTTOM OF THIS FORM. 

ALTERNATELY, YOU MAY ORDER DIRECTLY ON LINE VIA OUR SECURE SERVER.

 

 

 

 

NAME
COMPANY (Optional)
STREET ADDRESS
CITY
STATE
ZIP CODE
PHONE

 

 

IF ORDERING WITH CREDIT CARD:

 

CREDIT CARD TYPE	[ ] MASTERCARD   [ ] VISA
CREDIT CARD NUMBER
EXPIRATION DATE:	__/__

 

 

 

PLEASE RETURN TO:

 

BARRY C. PICKER, CPA

1908 AVENUE O

BROOKLYN, NY  11230