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Text File  |  1996-06-29  |  567 b   |  24 lines
  1.             Service Assistant Registration Form
  2.  
  3. Thank you for your registration. Your order will be shipped the same day
  4. it is received.
  5.  
  6.  
  7. Name:______________________________________________
  8.  
  9. Address:___________________________________________
  10.  
  11. State:__   Zip:_____ ____           Phone:___________________
  12.  
  13. Quantity:___   X   $49.00    ________.____
  14.  
  15. Shipping and handling---------     $5.00
  16.  
  17. Total---------------------- _________.____
  18.  
  19.  
  20. Send registration form and your cash, check or money order to.
  21. Ken Kellum
  22. 913 S. Earling
  23. Miles City Mt. 59301
  24.