SHUTTLE RESCUE ORDER FORM



       NAME: _____________________________________________


    ADDRESS: _____________________________________________


       CITY: ________________________   STATE: ___________


   ZIP CODE: ________________________ VERSION:         1.2



   PLEASE ENCLOSE A CHECK OR MONEY ORDER FOR $ 20.00
   MAKE THE CHECK PAYABLE TO:     LEIF MAGDEN

   SEND THIS COMPLETED ORDER FORM TO:     LEIF MAGDEN
                                          132 LOMA VISTA #5
                                          EL SEGUNDO, CA   90245