| Name: |
____________________
|
Address: |
____________________
|
| Phone: |
____________________
|
State: |
____________________
|
| E-mail: |
____________________
|
City/Zip: |
____________________
|
| Products: |
U.S.
Orders
|
*S/H
|
*Qty
|
Total
|
| World
War II Wrecks of the Truk Lagoon |
$70.00
|
$10.00
|
__
|
______
|
| World
War II Wrecks of Palau |
$65.00
|
$10.00
|
__
|
______
|
| Truk
Lagoon Wreck Divers Map |
$10.00
|
$4.00
|
__
|
______
|
| Palau
Dive Location Map |
$10.00
|
$4.00
|
__
|
______
|
| T-Shirt
(Aikoku M. design), size ______ |
$12.00
|
$4.00
|
__
|
______
|
| T-Shirt
(Fumitsuki design), size ______ |
$12.00
|
$4.00
|
__
|
______
|
| |
|
|
|
|
|
Grand
Total:
|
______
|
|
*Combination and/or multiple item orders: Customers
will be charged actual shipping costs via a secure virtual charge
transaction terminal.
Foreign Orders:
Customers
will be charged actual air mail or other category shipping costs
via a virtual charge transaction terminal.
|
| Payment
Method: |
|
| Visa
__ MasterCard __ AmericanExpress
__ Discover__ Money
Order __ |
| CC#
_______________________________________ Exp.
Date: ____ / ____ |
| Name
on Card: ____________________________________________________ |
| Signature:
________________________________________________________ |
Orders can be
sent via:
E-mail: nvdp@c-zone.net
/ Phone: (530) 246-7755
Or mail form with remittance
to:
North Valley Diver Publications
P.O. Box 991413
Redding, CA 96099-1413
