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| To order "The Silver Cord", please print this form and complete all information. Mail the completed form, along with a check or money order to the address listed below. |
| TO ORDER: Please send payment by check or money order. Each CD costs $12.00, plus shipping. -Please add $2.50 U.S. Funds for THE FIRST CD and $1.00 for each additional CD for postage. -If ordering from outside of the US, please include $4.50 for the first CD and $2.00 for each additional CD -Make your money orders or checks payable to Dennis Tice. MAIL THIS FORM AND YOUR CHECK OR MONEY ORDER TO: Joshua Quest Dennis Tice 503 South Juliana Street Bedford, PA 15522 YOUR NAME ___________________________________________ ADDRESS _____________________________________________ CITY ________________ STATE ______ ZIP CODE ___________ PLEASE CIRCLE ONE OPTION BELOW:
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