Stanley Lisica LLC

Stanley Lisica      P.O. Box One       New Baltimore MI 48047    USA
Fax: 586-716-7927 Email: Internet:

Date: ____________
Name:______________________________________________ Account # ______

Address: ______________________________________________________________________

City: ________________________________________ State: _____ ZIP: __________

Payment is:
____Enclosed in the amount of $ _______

____Please charge the amount of $ ______to my credit card __Mastercard __Visa

Account # ____________________________________ Expiration Date: _________
Cardholder signature:

U.S. Orders:
Shipped postpaid if over $20.00 otherwise add $1.00 on  orders under $20.00. If insurance wanted on orders under $100.00, add $2.10.
International orders: 
Shipped postpaid if over $40.00 otherwise add $2.00 on orders under $40.00. If registration wanted add $13.40 to all orders. No insurance available.
All stamps are mint, NH unless otherwise noted. STANLEY LISICA will not make any substitutions. Any item out of stock (o/s)  will result in refund. No credit slips are issued unless prior agreement is made.

Qty Country Scott/SG # Description Price Total Office Use
Postage, Insurance or Registration Charges (see above) .................$ ________


..............  $ _____