WaveShield 

Order Form
 

       Yes, please send me the WaveShield 1000. Enclosed is proper compensation corresponding to my choice below.  
Compensation is accepted in Cash, Check or Money Order.

Please send my order to:

Name: ______________________________________________________

Mailing location: _______________________________________________

City: _____________________________ State: ______________________

Postal number:   _________________  
 

_____  WaveShield 1000 - $18.95 + $5.95 Priority Mail (Total = $24.90)

_____  WaveShield 1000 SLIM - $18.95 + $5.95 Priority Mail (Total = $24.90)

Print out this form, fill it out and send it, with enclosed payment 
Send proper compensation in cash, check or money order only to:

Francis Steffan
c/o 6500 Shadow-Glen
Eagle-Point, Oregon.
97524    

Thank-you for your order.