DAYTIME TELEPHONE NO.
( )
AREA CODE
(ZIP CODE)
Check or Money Order payable to Helm, Inc. (USA funds only — do not send cash.)
MasterCard
VISA
Discover
Account Number: Expiration Date mo/yr:
CUSTOMER SIGNATURE
TOTAL MATERIAL
Michigan Purchasers add 6% sales tax
U.S. Order Processing
Canadian Postage
GRAND TOTAL
$6.00
Check here if your billing address is different from your shipping address shown.
GM-CHE-ORD99
*(Prices are subject to change without notice and without incurring obligation. Allow ample time for delivery.)
Note to Canadian Customers: All listed prices are quoted in U.S. funds. Canadian residents
8-13
are to make checks payable in U.S. funds.