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  1. Cannon Fire¬ Order Form
  2. Mail this completed form with payment to:
  3.  
  4. ╔by Design, Inc.
  5. 105 Tena Marie Circle
  6. Lodi, WI 53555
  7. USA
  8.  
  9. OR Phone us at (800)-527-7472
  10.  
  11. OR  e-mail information below to:  DESIGNINC@AOL.COM
  12.  
  13. First Name                                                            Last Name                                                  
  14.  
  15. Address                                                                                                              Apt#             
  16.  
  17.                                                                                                                                                 
  18.  
  19. City                                                   State                   Zip                   Country                       
  20.  
  21.  
  22. Daytime Phone:                                                                                                                       
  23.  
  24. E-Mail Address:                                                                                                                       
  25. __ Please E-mail me my order at the above address.
  26.  
  27. ____One copy of Cannon Fire¬ at Gettysburg $24.95
  28. ____One copy of Cannon Fire¬ at Shiloh $24.95
  29. ____One copy of Cannon Fire¬ at Chickamauga $24.95
  30.  
  31. ____One copy of Musket Fire¬ at Austerlitz $24.95
  32. ____One copy of Musket Fire¬ at Waterloo $24.95
  33. ____One copy of Musket Fire¬ at Borodino $24.95
  34.  
  35. ____Add $4 S&H for orders in North America
  36. ____Add $10 S&H for orders outside North America
  37.  
  38.  
  39. Method of Payment:       
  40.  [  ] Visa                  [  ] Mastercard                    [  ]  Check (payable to ╔by Design, Inc.)         
  41.  
  42. ___________________________________________________________________
  43. Account Number                                                                                                                                                Exp Date
  44.  
  45. ___________________________________________________________________
  46. Name exactly as it appears on the credit card