Magnum Rockets, Hobbies & More Inc.
P.O. Box 497
Nottingham, PA 19362-0497
610-932-2921

NAME:___________________________________ PHONE#:_____________ DATE:__________
SHIPPING ADDRESS:____________________________________________________________
CITY:_________________________ STATE:______________ ZIP:____________
TRIPOLI#___________ CONFIRMED?:   Y    N LEVEL:   1   2   3 NAR or
AMA#__________
QUANTITY DESCRIPTION OF PRODUCT PRICE TOTAL
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SUB TOTAL ______
PA Residents add 6% TAX ______
$20 Hazardous Fee (If Applicable) ______
Shipping ______
ORDER TOTAL ______

SIGNATURE:________________________________       AGE:_______

VISA / MASTERCARD #:__________________________-________** 

Exp. Date:____________

**Important! Please include last 3 digits of your MasterCard number as shown on the signature line on the back of your card.