PRINTOUT ORDER FORM
Print, complete, and mail to:
Dimension 21, Inc.
155 Park Ave.
Cranston, RI, 02905
Check or money order should be made payable to: "Dimension 21, Inc."
RI residents add 7% sales tax.
Name ____________________________________
Address ____________________________________
City ___________________________
State __________ Zip_____________
Phone ___________________________
E-mail ___________________________
VISA ___ MASTERCARD___ AMERICAN EXPRESS____
Name as it appears on card____________________
Card number________________ Expiration Date:__month __yr.
Select Item Price +S&H = Total
___ Blackjack Without Tears $395.00 $7.70 $402.50
___ Blackjack Reality $ 59.50 $5.45 $ 64.95
___ Flash-cards $ 34.95 $3.00 $ 37.95
___ Count Room $ 19.95 $0.00 $ 19.95
___ RI residents add 7% tax * * _______
x Total * * $ _______
Be in charge of the game, not at the mercy of it!
Page created and maintained by Dimension 21, Inc. © 1998-2003