City:__________________________ State:__________ Zip:__________

Item #: Item Description Price
 Tax (MI 6%) 
 Total Enclosed 

Card Type16 Digit Card Number      Expiration Date
Verification Number (from back of card)


Please make checks or money orders out to
Megan Bouchard

Print this form and mail it to the following address:
Megan Bouchard
P. O. Box 573
Hazel Park MI 48030-0573
If you wish, you can call us during business hours (8:30 AM - 5:00 PM ET) at (248)543-2696.