The Renters' ORDER FORM

Quantity Title Price Ea. Amount
_____ The Missing You Waltz @ $15.00 = $_____.___
_____ Renters from #@#*! @ $15.00 = $_____.___
_____ The Best Things In Life Are For Rent @ $15.00 = $_____.___
  Shipping & Handling $3.00 $    3.00
  Total enclosed: $_____.___
Ship to:

____________________________

____________________________

____________________________

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Enclose check or M.O. (US Funds)
and mail to:
Gary Gackstatter
321 North Third
Arkansas City, KS 67005