ORDER FORM SHEET

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#CC9966" TEXT="#080000" bgproperties="fixed" background="04600640dkesoe.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Medical Missionary Press</B></FONT><FONT SIZE="1" COLOR="#006633" FACE="Arial" > </FONT><FONT SIZE="1" COLOR="#FF3300" FACE="Arial" > </FONT><FONT SIZE="1" COLOR="#CC0033" FACE="Arial" > </FONT><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="Medical Missionary Press"><B>home</B></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CC9966" TEXT="#080000"> <div> <A HREF="index.htm" TARGET="_top" TITLE="Medical Missionary Press"><IMG SRC="0410d0d0.png" border=0 width="13" height="13" ALT="up" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></A>       <A HREF="id20.htm" TARGET="_top" TITLE="Materials List Order Form"><IMG SRC="042070d0.png" border=0 width="7" height="13" ALT="previous" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></A>      <A HREF="id22.htm" TARGET="_top" TITLE="Country Living"><IMG SRC="043070d0.png" border=0 width="7" height="13" ALT="next" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></A>      <IMG BORDER="0" SRC="1x1.gif" HEIGHT="13" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="13"></div> <div> Minimize this bar, and maximize the window to view the full order sheet. This sidebar can be minimized by dragging the right edge of the bar to the left as far as possible.</div> </td> <td valign="top" height=390 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> ORDER FORM SHEET</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="969" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM ROWSPAN=4 HEIGHT= 23 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM COLSPAN=3><NOBR><div> <B>MEDICAL MISSIONARY PRESS ORDER FORM</B></div> </NOBR></tD> <tD VALIGN=BOTTOM ROWSPAN=4 COLSPAN=2 WIDTH="243"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="243" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><div> <B>2005</B></div> </tD> <tD VALIGN=BOTTOM ROWSPAN=4 WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="512"><div> 474 Blue Hill Road, Marshall, NC  28753</div> </tD> <tD VALIGN=BOTTOM ROWSPAN=3 WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM COLSPAN=3><NOBR><div> Phone: (828) 649-3976     Fax: (828) 649-0070</div> </NOBR></tD> </tR> <tR> <tD VALIGN=BOTTOM COLSPAN=3><NOBR><div> Email: mmpress@mmpress.info    Website: www.mmpress.info</div> </NOBR></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM><NOBR><div> INSTRUCTIONS: Print this sheet out and fill it out if mailing to us.</div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 39 WIDTH="64"><div> <B>Qty.</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="378"><div> <B>Title or Description</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="64"><div> <B>Sect. #</B></div> </tD> <tD VALIGN=BOTTOM><NOBR><div> <B>Page #</B></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> Size, item #, or author</div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="57"><div> <B>Price ea.</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM><NOBR><div>   Total</div> </NOBR></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><div> 1</div> </tD> <tD VALIGN=BOTTOM COLSPAN=3><NOBR><div> Subtotal of items with special shipping charges</div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><div> 2</div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="512"><div> Subtotal of other items</div> </tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><div> 3</div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="512"><div> Shipping in U.S. - 10% of line 2</div> </tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><div> 4</div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="512"><div> Complete Subtotal - Add lines 1 through 3</div> </tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><div> 5</div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="512"><div> NC residents add 7% of line 4</div> </tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><div> 6</div> </tD> <tD VALIGN=BOTTOM COLSPAN=3 WIDTH="512"><div> Tax-deductible Donation </div> </tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><div> TOTAL</div> </tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 23 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM><NOBR><div> Shipping on International orders</div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="23" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><div> call or email us at the address at top of page</div> </tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM><NOBR><div> All orders are to be in US$</div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 33 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="33" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><div> OR you may add 15% of line 40 + $4.00</div> </tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="33" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="33" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><div> <B>We do NOT process Credit Cards</B></div> </tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="33" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="33" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="33" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 31 WIDTH="64"><div> Name<FONT SIZE="5" COLOR="#000000" FACE="Arial" >:</FONT></div> </tD> <tD VALIGN=BOTTOM COLSPAN=7 WIDTH="878"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="31" ALIGN="bottom" WIDTH="878" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 31 ><NOBR><div> Address<FONT SIZE="5" COLOR="#000000" FACE="Arial" >:</FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM COLSPAN=7 WIDTH="878"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="31" ALIGN="bottom" WIDTH="878" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 30 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM COLSPAN=7 WIDTH="878"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="878" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 31 ><NOBR><div> Phone<FONT SIZE="5" COLOR="#000000" FACE="Arial" >:</FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="31" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM COLSPAN=6 WIDTH="497"><div> Email<FONT SIZE="5" COLOR="#000000" FACE="Arial" >:</FONT></div> </tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 16 WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="378"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="378" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="183"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="183" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="57" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> </td> </tr></table></body>