HDEL, Inc.

PO Box 679051

Orlando, FL 32867

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

If ordering computer product(s) please circle correct operating system.:

Windows 2000, ME, NT, XP, VISTA, WIN7

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:________________________________________________________

Credit Card number: ________________________________________________

Exp. Date: ___________________________________________________

CCV:=Last 3 digit number on the back of the card__________________________

Signature (Required):________________________________________________

Date: ____________________________________________________________