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** Order Form: Online Tom Burgoon Store **

Please print this form, complete your request and send to:
TOM BURGOON MAGIC PRODUCTIONS LTD.
P.O. Box 17740
Kansas City, Missouri 64134 USA
Phone: 816-560-4260 | Email: tom@tomburgoon.com

Make check payable to: Tom Burgoon

Name:  
Phone:  
Street:  
City:  
State and Zip Code  
E-Mail  
Item Name Quantity Price Each TOTAL
       
       
       
       
       
Alternate choice if one is not available:      
       
       
    Merchandise Total:  
    Sales Tax x.xx%
(MO only)
 
    Shipping & Handling
0.00 (included)
    TOTAL AMOUNT ENCLOSED:  
Payment Method: _____ Personal Check _____ Money Order

Signature:

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