Attn: Individual Returns

47-50 33rd Street

Long Island City, NY 11101

(718)-729-8890

Battery

$ 4.00

Case

10.00

Bezel

6.00

Band(Polyurethane)

12.00

Band(Leather)

12.00

Band(Metal)

20.00

Band(Nylon)

7.00

Processing and handling

8.50

 

________

Total

$

Check or Money Order

Master Card

Visa

__________________________________

Account#Expiration Date

__________________________________

Printed Name

__________________________________

Address

__________________________________

__________________________________

__________________________________

Phone Number

__________________________________

Signature

716004-1-2

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Freestyle 634 Xterra, 716 Xterra operating instructions 716004-1-2