Bruce-Hopkins.com Merchandise Order Form ______________________________________________________ Ship To: Name:____________________________________________________________________ Street Address: ____________________________________________________________ __________________________________________________________________________ City: ______________________________________________________________________ State/Territory: _____________________________________________________________ Country: __________________________________________________________________ Postal/Zip Code: ____________________________________________________________ Email Address or Phone Number (Optional, in case we have a question about your order): ___________________________________________________________________________ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
*PRINT THIS FORM, FILL IT OUT, AND SEND IT WITH PAYMENT* Make checks/money orders payable to: Ellen Rollo Questions about your order? Email: bhquestions@aol.com Mail order form and payment to: Website: http://www.bruce-hopkins.com/merchandise.html Bruce Hopkins Website P.O. Box 3 Uniondale, NY 11553-0003 *If using PayPal, please refer to Merchandise page for instructions*
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