| Total Price | $_____________ |
| Name | __________________________________________ |
| Address | ________________________________________ |
| City | _________________ |
State | _______________ |
Zip | _______________ |
| My check | Money Order | is enclosed |
Postage and handling is included. NY residents add sales tax.
Mail to:
J. Palazzolo Son, Inc.
36 Lakeville Road
New Hyde Park, New York 11040