PLEASE PRINT THIS FORM OUT, AND SEND IT BY REGULAR MAIL!
               MAIL AND FAX ORDER FORM:

First reserve by E-Mail all the Items that you like!
To order by Mail or Fax, you can print this Text file,
fill it out, and then Mail or Fax it to: 1-352-637-0542

E-Mail Address:   ________________________________
Your Name:        ________________________________
Address:          ________________________________
City, State, Zip: ________________ __ ____________
Home Phone:       ________________________________

The Items you which to Order:

 1)Item:__________Stock No___________________Amount $_______
 2)Item:__________Stock No___________________Amount $_______
 3)Item:__________Stock No___________________Amount $_______
 4)Item:__________Stock No___________________Amount $_______
 5)Item:__________Stock No___________________Amount $_______
 6)Item:__________Stock No___________________Amount $_______
 7)Item:__________Stock No___________________Amount $_______

Please send the above Items for a total of:         $_______
Plus $7.80 for Priority Mail including insurance,
for about 4 figures, when shipped inside the USA.   
Larger Orders may need more Poastage, please ask!   $_______

Orders from other Countries, please keep in mind
that Airmail is faster but cost more then surface.
Larger and out of Country Orders will be charged 
the actual cost of Postage paid by us, and since
we will only know that amount after the shipping,
we will need your Credit Card Number on file.       $_______

Please charge my Credit Card Account the total of?  $_______ 
Credit Card No:   ____-____-____-____Exp.Date__/__

Signature:        ________________________________


I include a US Money Order or Personal Check for?   $_______
Make Payable to, "H. Van Niersen" and Mailed to:

H. Van Niersen
12561 E. Gulf To Lake Hwy.
Inverness Fl. 34450
Trekshop01@aol.com
__________________________________________________________________
Important:
We can take Orders by Phone! We live in Florida so please call
during our FLORIDA business hours, Fax orders may work better!
Money order Customers can expect the shipment in 2 to 3 weeks.
Credit Card orders, can expect there shipment in 1 to 2 weeks!
If you like to call us at 1-352-637-3208

We Thank you for your order!
And hope to hear from you again!
The Van Niersen's