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 Order Form

1. Complete this form and read the disclaimer.
2. Print it and mail it to the address below. U.S. FUNDS ONLY!
3. We accept only Money Orders and Checks. Money Orders will speed up the turn around time.
Fields with * next to them are required. Orders without these fields completed will not be shipped.

Name Email Address*

Address*

City* State* Zip Code*

Quantity of Mod Chips ordered ($13.00@)

What model Playstation do you have?

Comments:

I have read and agree to the Disclaimer (Yes, No)*

(If you haven't read the disclaimer, your order won't be shipped.)

Make checks payable & Mail To:

ghjk66@go.com
 You must still mail in your order and payment, even if you Email your order to me.
By ordering, you agree to the terms and conditions set forth in the disclaimer page.
 All sales are final.