ORDER FORM Pocket Slipper Laser Aimer

Name:

Address:

City/State/Zip:

Telephone:

Credit Card Information:

Credit Card Type (circle one): Mastercard Visa Discover AmEx

Card Number: Exp Date:

CVV Number:* (see below)

Signature:

*This is the 3 or 4 digit number in the signature panel on the back of your credit card.

Please print, fill out and mail this order form to the address below. Please include your credit card information above, or include your check or money order for $120.00, payable to L.W. Seecamp Co., Inc.

L.W. Seecamp Co., Inc.
280 Rock Lane
Milford CT 06460

FAX ORDERS: Credit card customers may print this form and fax it to (203) 877-3429
PHONE ORDERS: Order by credit card during business hours by calling (203) 877-7926

Please email info@seecamp.com for approximate delivery time.
CT residents add 6% sales tax.