ORDER FORM

Original Wild Game, Fish, and Seafood Recipes

Please send check or money order in the amount of $20.00
Plus $5.00 for tax, shipping and handling to:

Dale L. Shelly
P.O. Box 6070,
Wyomissing, PA 19610

We accept Visa and Master Card.

Please forward _________ copies of
Original Wild Game, Fish and Seafood Recipes to:

Your Name:	_______________________________________
Mailing Address:	_______________________________________
City:	_______________________________________
State:	_______________________________________
Zip:	_______________________________________
Phone:	_______________________________________
Credit Card:	[ ] Visa [ ] Master Card
Number	_______________________________________
Expiration Date:	_______________ CVV Code______________

(CVV Code is found on the back of your credit card, last 3 numbers)

Enclosed is my check/money order in the amount of                  $____________

You are authorized to charge my credit card in the amount of      $____________

Signature:___________________________________
                   (Signature Required for Credit Card Orders)

Or call (610) 375-7925 to place your order by phone!

dalescookbook.com