Order Form
(Printable)

A subscription to the 2010 Edition Services Directory
May be ordered by sending 20.00 plus $5.00 for shipping and handling.
Simply fill in the information and send to:

Jerry Howard.com
PO Box 279
Dexter, MO 63841

Please print
Name:________________________________________________________________

Billing Address:________________________________________________________

City: _________________________________ State: ____ Zip Code: _____________

Phone Number: ____________________________________________________

email: (optional) _____________________________________________________

Number of copies requested: ____X $25.00 includes S & H = ___________

Total amount enclosed $_____________

Signature: _______________________________________

Signature verifies purchase order and purchaser as agent for:

Name: ________________________________________

(Shipping Address: Please fill in, if different than above)

Address: ______________________________________

City, State, Zip: _________________________________

For more information you may visit our website at www.jerryhoward.com or call
573-624-2246 or fax to 573-624-2887.

Please allow two weeks for delivery