NAME:                                                    MAIL ORDER TO:
ADDRESS:                                                 VVnW SALES
                                                         760 JUMPER ROAD
TELEPHONE:   (    )                                      WILKES-BARRE, PA 18702-8033

  ITEM#   |       DESCRIPTION     | QTY  | SIZE | COLOR  | PRICE EACH  |  AMOUNT   
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                                                            SUB TOTAL:             
Make check or money order                      PA RESIDENTS ADD 6% TAX:            
payable to: VVnW, Inc.       POSTAGE AND HANDLING (on orders over $10.00):     $3.00  
                                                       	     TOTAL DUE:            

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