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Roy Weid
P.O. Box 3461
Big Bear City, Ca. 92314-3461
phone/fax (909) 585-4729     r.weid1@verizon.net

Date: ____/____/____
Your Full Name: _________________________________
Address: _______________________________________
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State: _____________________  Zip: ________________
Day phone: (        ) _____-__________
Part# Qty Description Unit Cost Total
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Shipping:____________________________________ Sub-Total:__________
Orders to $150.00 add $15.00 Shipping:___________
Orders over $150.00 add 9% of total  
PLEASE MAKE CHECKS PAYABLE TO "ROY WEID" Total:_______________

I Assume Complete Responsibility for the use of all Public Enemy Kits and Supplies.

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