Date: __________________

Title:   ___ Mr.     ___ Mrs.     ___ Ms.     ___ Miss

First Name: _________________   Last Name: _______________________

Street Address: _________________________________________

______________________________________________________

City: ____________________________   State: ____     

Zip Code: __________  Country: _______________________

Phone: _____________________   Email: __________________________

I am enclosing $29.95 for the professionally printed Blackjack book. (Your professionally printed  book will be shipped to you--FREE shipping; no tax.

Send your check or money order to Blackjack, PO Box 747,
Walnut, CA 91789. Phone: (909) 464-0500