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Use this form to purchase Blackjack products by Cash, Credit Card, Check or Money Order.


After printing fill out the form below and mail to:
Gary T. Johnston
1721 Gates Street
EUREKA, CA  95501

SHIPPING INFORMATION:
Name:    _______________________________________
Address:    _______________________________________
        _______________________________________
        _______________________________________
E-Mail:    _______________________________________
Phone: _____________________________________
CONTACT INFORMATION (if different):
Name: _____________________________________
Street & Number: ______________________________________
City, State, postal code: ________________________________
Country: _______________________________________

Credit card information: CIRCLE ONE
Credit card: Visa - MasterCard - American Express
Card Holder: ________________________________
Card No.: ___________________________________
Expiration Date : ___________________________________
Date / Signature: ____________________________________________
PLEASE CIRCLE YOUR CHOICE(S):
  1. The Precision Blackjack Home Study Course = $397.00
  2. Today's Blackjack - The PBJ Mini-Manual = Discontinued
  3. Boris PBJ & Today's Blackjack/Mini-Manual = Discontinued