| Order Form for U.S.A. |
| Quantity | Description | Price Each | Total $ |
| Airmail Handling & Packing at Buyer's Risk, or... | $10.00 | ||
| ...Fully Insured Shipping | $20.00 | ||
| Check enclosed payable to "Chard" | Total | $ |
Please mail to:- (Use an address sticker if you wish.)
| Name |
| Street Address |
| Town / City |
| County / State |
| Country - USA |
| Zipcode |
| E-mail address for advice of despatch |
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