Print out this order form

Send completed form and check or money order to:

LAMBERTVISION

451 S. HARVARD #324

LOS ANGELES, CA 90020

_____________________________________________

  POWER COLLECTION ORDER FORM

MAKE MONEY ORDERS & CHECKS PAYABLE TO RAYMOND LAMBERT

Name of collection 1._______________________ $14.00

Date __/__/__

SHIP TO:

Name___________________________________

Address_________________________________

City______________________State____________Zip____________

Country_______________________

e-mail________________________

phone________________________

SHIPS DAY AFTER PAYMENT IS RECEIVED (U.S. MAIL)