| Receive the gift of the VRIL Generator by check or money order, or International money order through the mail |
| please
print this form, fill it out and mail with
Check or Money Order to: James G. Gavin upon receipt of your check, money order, or International Money Order you will be notified by email of the time of the shipment of the gift of the VRIL Generator to your address (receipt of VG is within 4 days) Name _________________________ City _________________ State(province) ______ (shipping of the gift of the VRIL Generator free in the USA or International by priority mail) International Orders: please pay by International Money Order payable in US dollars number of VRIL Generators/Memberships _______
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if you have any difficulties filling out this form or have further questions contact onelighta@yahoo.com |