HDEL, Inc.

625 Merritt Ave Suite (K)

Merritt Island, FL 32953

Toll Free: 1-866-242-9552

Email: hdel@hdel.com

http://www.hdel.com

Name:_________________________________________________

Address:_______________________________________________

City:__________________________________________________

State:_________________________________________________

Zip: ____________________________________

Note: For Oversea address use APO;AA;AE AP which ever one you are.

Phone: Include area code.

_________________________________________

Email: ____________________________________

AFSC: ___________________________________

Note: List ie. 2W151A, 2W151B, 2W171

List Products you are ordering. (Item/Cost)

1. ________________________________________________Cost:__________

2. ________________________________________________Cost:__________

3. ________________________________________________Cost:__________

4. ________________________________________________Cost:__________

Shipping & Handling: $12.00

Florida Residents add 6.5% sales tax____________________________________

Total Cost:_______________________________________________________

Signature (Required):________________________________________________

Date: ____________________________________________________________