MAPS/EC P.O. Box 10616 Portland, OR 97296-0616 NAME (Please Print)________________________________ (CIRCLE ONE) VISA MASTERCARD AMEXCO CARD NUMBER________________________________________ EXPIRATION______________DAY PHONE ( )____________ SIGNATURE__________________________________________ BILLING ADDRESS: ___________________________________________________ ___________________________________________________ ___________________________________________________ SHIPPING ADDRESS (if different from mailing) CHECK ONE Residence____ Commercial____ ___________________________________________________ ___________________________________________________ ___________________________________________________ QTY TITLE LBS COST TOTAL ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ ___/ ____________________________/ ____/ $________/ $_________ SUBTOTAL $___________ SHIPPING FEES $___________ (see ordering info. for shipping fees) TOTAL $____________ Our catalog continues to exist almost entirely because our customers have wanted their friends and associates to know about our products. Is there anyone you know that we could send a free catalog to? Thank You! NAME_______________________________________________ STREET ADDRESS_____________________________________ ___________________________________________________ CITY______________________STATE____ZIP_____________