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FreeStyle U.S.A.
Attn: Individual Returns
5855 Olivas Park Drive
Ventura, CA 93003
PRICE
TOTAL
Battery
Case
Bezel
Band(Leather)
Band(Nylon)
Band(Metal)
California residents
add 7.00% tax
Processing and handling
Total
O Check or Money Order
O Master Card
O Visa
__________________________________
Account #
__________________________________
Expiration Date
__________________________________
Signature (required for credit purchase)
$ 4.00
10.00
6.00
10.00
6.00
15.00
8.00
$
888004-2-1 rev. 6/01