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"Quick-Glance" Mail-In Order Form
Mail to:  "Quick-Glance"
        P.O. Box 3075
        Santa Clarita, CA 91386-3075

(Please print clearly)


Your Name:_______________________________
Mailing Address:___________________________
                              City:________________________
          State/Province:________________________
                      Country:________________________
                               Zip:________________________

Favorite Channels (i.e., Discovery, HBO, Disney, etc.):

        1. _____________        6. _____________
        2. _____________        7. _____________
        3. _____________        8. _____________
        4. _____________        9. _____________
        5. _____________      10. _____________

Personalized Background Color:

    O Pink    O Purple    O Powder Blue   O Peach    O Green

    

Payment Enclosed:    O Check    O Money Order


"Quick-Glance" Channel Guide @ $1.25 each  X  ____  =  $ ________


"Personalized" for only $1.00 each                     X  ____  =  $ ________


 Shipping & Handling @ $.75 each                     X  ____  =  $ ________


                                                                          Total Enclosed  $ ________