Please print* and send the order form with your payment: * Use Courier font (or other mono-spaced font) when printing! ps.- I am always looking to buy old arcade games and parts. ====================================================================== LV2000 Order Form ----------------------------------------------------------------------- DATE: ----------------------------------------------------------------------- Send check or money order to: Jeff Hendrix 14163 Jared Ct. Broomfield, CO 80020 ----------------------------------------------------------------------- Ship to: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ ----------------------------------------------------------------------- Your email address: ----------------------------------------------------------------------- QUANTITY DESCRIPTION PRICE EACH TOTAL -------- ------------------ --------------- --------- [ ] Assembled Kit $ 35.00 (3/$100) _________ Sub-Total: _________ Shipping: 3.00 TOTAL: ========== ======================================================================