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Use this form to order any product by check or money order. USA Only

1. Print this form
2. Complete the required items.
3. Make Check payable to: Smiley & DeCarlo
4. Mail the completed form with check or money order to:

Ship To:

NAME__________________________________________________________
											 
ADDRESS_______________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

E-MAIL ADDRESS (for shipping notification)________________________

Quanity	Price	S&H	TOTAL
1 HieroNote CD	$19.95	$3.00	$22.95
2 HieroNote CD's	$39.90	$4.50	$44.40
3 HieroNote CD's	$57.86	$6.00	$63.86
4 HieroNote CD's No add'l s&h	$74.81	$6.00	$80.81
5 HieroNote CD's No add'l s&h	$90.77	$6.00	$96.81
6 HieroNote CD's No add'l s&h	$105.74	$6.00	$111.74
7 HieroNote CD's No add'l s&h	$119.70	$6.00	$125.70
8 HieroNote CD's No add'l s&h	$132.67	$6.00	$138.67
9 HieroNote CD's No add'l s&h	$144.64	$6.00	$150.64
10 HieroNote CD's No add'l s&h	$155.61	$6.00	$161.61