Drag News CD Mail-In Order
Form
Print Out -
Fill Out - Mail In (US Funds Only)
Please send me the following Drag News CD VOLUME 1 "THE EARLY YEARS" 1955 - 1961
Total: ________________
Please send me the following Drag News CD VOLUME 2 "THE GOLDEN YEARS" 1962 - 1966
Total: ________________
Please send me the following Drag News CD VOLUME 3 "THE GOLDEN YEARS" 1967 - 1971
Total: ________________
Please send me the complete Drag News CD Set (5 discs) VOLUMES 1 thru 3 - 1955 - 1971
Total: ________________
Please send me the following Clear Plastic Display Case for 1/24 scale 1320 diecast dragsters
Total: ________________
______________________________________________
Name: ___________________________________________________________
Company: ________________________________________________________
Shipping Address: __________________________________________________
City: _____________________________________________________________
State: _______________________________________ Zip Code: _____________
Mailing Address (if different): _________________________________________
Phone (Days): ____________________ Phone (Eves): ______________________
e-mail Address: ___________________________________________________
Special Instructions:________________________________________________
Select Payment Type: (include payment with form)
Check Payment Type: _____Cashiers _____ Money Order _____
Certified Check
_____ Personal Check _____ PayPal*
Check Number: __________ (personal checks need to clear our bank
before order is shipped)
For Credit Card Payments Diecast:
Credit
Card Order
For
Credit Card Payments Drag News CD: Credit
Card Order
Make checks payable to: Left
Coast Web Graphics
Mail Order Form To:
Left Coast Web Graphics
210 SW Pine St
Grants Pass, OR 97526
Phone: 541-955-7130 E-mail: Diecast