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Please fill out the following form, following the instructions through out.


Address

Your Name:   
E-mail Addr: 
Address:     
Address:     
City:         State:  Zip:  

Product Ordered

Delivery Method

By postal mail (Add $3 to base price). You must include your full address! Even if you want postal delivery, you should include your email address.

By E-mail with enclosed Zip (Free - the base price is your total cost!). Don't forget to include your email address! You do not have to include your postal address if you wish.


Payment

If you pay by check, please make it payable to Alan Robinson. If you choose to send cash, please obscure it by wrapping the bill(s) in newspaper or some other colored/textured paper.

Comments (optional)


Now push the print button in your browser, and then send this form along with the appropriate payment to:

HCI Design
1108 Old Furnace Road
Floyd, VA 24091