Logbook 1.2 by KB9LEB
Order Form
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Please PRINT legably in dark ink.

Full Name: __________________________________________________________

Street Address: _____________________________________________________

City, State, Zip: ___________________________________________________

Phone Number: (_____) ________ - _________________

E-Mail Address: _____________________________________________________

Homepage: http://____________________________________________________


Please make checks out to Jack Sterba for your determined amount. Send this form and your
check to...


Jack Sterba
2632 Turnbull Estates Drive
New Smyrna Beach, FL 32168

Thanks for your support!!