HTM Order Form-Please print and fax your order to: 570-363-2337

Name_______________________________________________

Address _____________________________________________

City, State, Zip_________________________________________

Telephone ____________________________________________

Model Number(s) & Item

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_____________________________________________________

______________________________________________________________

______________________________________________________________

Method of Payment _____________________________________

Card Number___________________________________________

Exp. Date ___________________

Fax to: 570-363-2337

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