Order Form
for
"Media Tried, Justice Denied"
Name
Address
City, State &
Zip Code
Country
_____________________________________
_____________________________________
_____________________________________
_____________________________________
ITEM
PRICE
QTY
TOTAL
REGION (circle one)
USA
Canada
Europe
$ 50.00
$ 65.00
$ 85.00
_______
$_____________
Shipping & Handling:
USA
International
$ 5.00
$ 10.00
_______
$_____________
GRAND TOTAL
$_____________
Enclose check or money order for total amount and mail to:
Ad...vice Marketing, Inc.
2009 Wanderlust Drive
Lewisville, TX 75067
USA
Ordered from Darlie Routier's Web Site