ZAPPER ORDER FORM

 1. PRINT PAGE

 2. FILL IN BLANKS

 3. SEND WITH PAYMENT MADE PAYABLE TO:

     Parrish
     27916 Klahr Rd.
     Parma ID 83660
     USA

 US FUNDS ONLY

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 FOR: ZAPPER

 CHARGE: $10 PER ZAPPER

  ADD $2.00 S + H OUTSIDE OF US


 QUANTITY: _____

 TOTAL PAYMENT: ___________

 SHIP TO:

 __________________________________

 __________________________________

 __________________________________

 __________________________________

 CONTACT:

 Phone: ___________________________

 Email: ___________________________

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