Mail Order Form

* Print the form.

* Fill in all the information completely and clearly.

*Make check or money order payable to : William Richmond

*Put in an envelope, with proper postage

* Mail the form and check to

William Richmond

290 Scottsdale Rd.

Pleasant Hill, Ca. 94523

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Your Full Name :______________________________

Mailing Address:__________________________

City:________________________

State:______ Zip Code:_________Country:_____________

E-MAIL Address:___________________

(example: username@aol.com )

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        Please send me the Special blend Fish Food ..........Reg. $29.99 for 5oz.

( I understand shipping is free in the USA.)

Add $9.50 for shipping and handling to check,  if out of USA

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check out

Andre's AQUARIUM CLUB

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