Mail in Order Form - Surfworm ISP Guide

		Mail In Order Form
		This form is for Checks or Money Orders ONLY! If you want to pay by credit card, please go back to the order page and choose BUY NOW. Please print this form and mail it along with payment to: Surfworm - ISP Guide 157 Whitney Lane Lampe, MO 65681 Make all checks payable to Surfworm.
	First Name		Last Name

	Address

	City		State or Province			Zip code or Postal code

	Country
				Purchase

					ISP Guide w/ Shipping (no tax) $54.45
E-mail address or phone number
					ISP Guide w/ Shipping and Tax $57.43 (Missouri Residents only)

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