HistoriFigs

P.O.BOX 744, Portage, WI 53901

Name:  _______________________________________ Date:  __________

Address: _____________________________________________________

City: __________________________ State: _______ Zip code: _________

Telephone: __________________________   Payment Enclosed: ___________

Credit Card Number: ____________________       Visa / MasterCard / Discover

Expiration Date: ________________ Signature: ________________________

Make checks payable to HistoriFigs                                                   Total _____________

Wisconsin  residents add sales tax of 5.5%                                      Sales Tax _________

See Shipping Chart for shipping & Handling                                 S&H _____________

Payment in U.S. funds only                                                                  Total _____________