CD-ROM Order Form FORM

I would like to order a CD-ROM with Blacksmith's Gazette issues:

______ CD-ROM with issues from _______ Year (1999 to 2006) Price is $25.00 per year

______ CD-ROM with all issues from January 1999 through December 2006. Price is $95.00

Name:____________________________________________________________ ____

Address:_________________________________________________________ _____

City: __________________________________, State _______ZIP_______________

E-Mail Address: _________________________________________________________

Print out , fill in, and mail this form, along with your check, cash, money order or Charge Card data (use form below) to:

Blacksmith's Gazette
P.O. Box 2168
Snohomish, WA 98291-2168

We accept Visa and MasterCard for CD-ROM's. To use your charge card fill in the data below.

Yes, I want to use my Charge Card:

I have a (Visa or MasterCard), please circle one.

My Card Number is:___________________________________________________

The Name on My Card is: _______________________________________________

The Expiration Date is: __________________________________________________

By Signing below, I authorize you to charge my subscription to the above charge card.

Signature: _____________________________________________________________

Mail this form to the above address or fax the filled in form to: (360) 668-1798 or call in to (360) 668-0976.