ORDER FORM NAME: _____________________________________________ DATE:____________ STREET ADDRESS:_______________________________________________________ CITY:_____________________________ STATE:_____ ZIP:___________________ ( ) Check ( ) Disc ( ) MasterCard ( ) VISA Sig._________________ CARD NUMBER:___________________________________ EXP DATE: ____________ ===================================================================== Item # Description Price # Ord. Total ====== ================================= ===== ====== ======= _____ ________________________________ $_____ ______ $______ _____ ________________________________ $_____ ______ $______ _____ ________________________________ $_____ ______ $______ _____ ________________________________ $_____ ______ $______ _____ ________________________________ $_____ ______ $______ _____ ________________________________ $_____ ______ $______ _____ ________________________________ $_____ ______ $______ Cat Printed Catalog N/C ______ Shipping & Handling $ 3.50 Sales Tax (Texas orders only - 8.25%) $______ Total Enclosed $______ Mail to: The House of Gutenberg Cy Stapleton 1601 Hanks St. - Post Office Box 151107 Lufkin, Texas 75915-1197 (409) 637-7468, FAX (409) 637-1480