NAME ___________________________________________________________ DATE ____________________
ADDRESS ________________________________________________________
CITY ____________________________________________________________
STATE _________ ZIP ___________________ DAY
PHONE _______________________________
PAYMENT METHOD
ENCLOSED IS MY
CHECK OR MONEY ORDER PAYABLE TO GOLDINHANDS
CHARGE TO MY
CREDIT CARD.
VISA MASTERCARD
CARD
NUMBER _____________________________________________ EXPIRATION
DATE ___________
CARD HOLDER'S
NAME ___________________________________________
SIGNATURE ____________________________________________________