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Rhame House Publishers

P.O. Box 1138
Wheaton, IL 60187

Just print out the form, fill it out, and send it to the address above!

Rhame House Publishers proudly offers these books by James Lyles;

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Ship to:

Name _________________________________________________________

(Need a street address for UPS)_______________________________________________

City, State, and Zip Code___________________________________________________

Sold to:

Name as it appears on credit card________________________________________________________

Billing Address for Visa/MC if different from shipping address. ______________________________________________________

City,State__________________________________________________________________________Zip Code_______________

Contact Phone Number of Card Holder _________________________________________________

Contact E-mail address for updates on shipping _________________________________________________

Replica .....................................................................................$________

Dummy Ammo ..........................................................................$________

Other.............................................................................$________

Shipping, insurance, crating/packaging.........................................$________

Total...........................................................................$________

Visa/Mastercard #__ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __ Expiration __ __/ __ __


3 - Digit code from back of card __ __ __

OR

Check or money order is enclosed in the amount of $____________________ payable to Dan Rhame

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 Signature_____________________________________________________Date _____________________

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page update May 2012