--------------[ POW Productions Order Form ]-------- Powball 1.03
POW Productions
Attn: Steve Wolfe
1965 West 4055 South
West Valley City, UT 84119
U.S.A.
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Please check the appropriate boxes below and add up the totals.

This order form is for orders in the USA and Canada. Prices are
in AMERICAN DOLLARS.

Please make Check or Money Orders payable to STEVE WOLFE.

[ ] Powball (3.5" High Density disks only)........(@ $12) _______

                    USA/Canada Shipping & Handling (@ $3)
                             (International add $2 extra) _______

                        Utah residents must add 6.25% tax _______

                                           Total enclosed _______


        Name: ___________________________________________________

     Address: ___________________________________________________

City, ST Zip: ___________________________________________________

     Country: _______________________  Phone: ___________________


Thankyou!
