ASUNDER MERCHANDISE 

MAIL ORDER FORM

To order by mail, please print out and send in this completed form with
a check or money order to the following address: 

Asunder Merchandise
PO. Box 2392
Petersburg, VA 23804-9904

Please make payments payable to:
New Millennium Releasing

ITEM

PRICE

QTY

$13.50

TOTAL

SHIP TO:

Name: __________________________________

Address:________________________________

________________________________________

Phone #:________________________________

E-mail: ________________________________

*NOTE: All prices include Shipping & Handling

Please allow two to three weeks for order processing and shipping.