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Print this form, fill out and mail to-

K. Mann 4176 N. Thistle Dr. Florence, AZ 85232


Please send me _______ Verne Langdon's ZOMBIE masks.

At a cost of $140.00 each.

For a total of $ _______.

My name is ________________________________

My address is ______________________________




I understand that I will recieve a numbered copy of

the mask as well as a certificate of authenticity.

Please allow 4 weeks for delivery, as each mask is hand made.