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[Print this page, fill out the form and mail to the address shown below]

MAIL-IN ORDER FORM

Rick's Lighthouse Screensaver - Best of Southern Atlantic Lighthouses

Name: ____________________________________

Full mailing address: ____________________________________

____________________________________

E-mail address: _____________________________

QTY COST

___ _____ Purchase Registration Key ($10.00 US) (Key emailed)

___ _____ Purchase CD with registration key ($15.00 US) (U.S. Mail)

_____ CT residents add 6% sates tax

_____ International orders add $1.25 US postage for each CD

_____ TOTAL

Gift Order - check here ( )

Registration to be made out in the name of: ______________________

Make checks payable to "Rick Totton"

Mail order form to: Rick Totton, 719 Still Hill Road, Hamden, CT 06518

All pictures are the original work of Rick Totton and are protected under copyright laws.

Do not reproduce any images from this website without permission of the author.