E-mail address: (if any)_________________________________
Shipping Address:___________________________________________________________
City, State, Zip______________________________________________________
Telephone:_________________________________________________________
Fax, If any:_________________________________________________________
______ - _____-__________________________________-___________
______ - _____-__________________________________-___________
______ - _____-__________________________________-___________
______ - _____-__________________________________-___________
______ - _____-__________________________________-___________
-----------------------------------------------------------------------------------------------
SubTotal - ______________________________________-__________
6% tax (FLORIDA residents only)_____________________-__________
Add (see chart) for shipping & handling in U.S. only __________-___________
Total Enclosed_____________________________________-__________
Shipping charges:
Add $9.00 for s&h for all orders up to $35.00
Add $14.00 for s&h for all orders from $35.01 to $70.00
Add $20.00 for s&h for all orders from $70.01 to $99.99
Add $25.00 for s&h for all orders from $100.00 to $149.99
Add $30.00 for s&h for all orders from $150.00 to $199.99
Free s&h on all orders over $200.00 in U.S. only!
(48 states only)
Please charge to my Visa Card:_____
Please charge to my Master Card:_____
Please charge to my American Express:_____
Please charge to my Discover Card:_____
Name on the credit card:___________________________________________
Credit Card number:______________________________________________
Expiration date:__________________________________________________
CVV2 number located on back of card:_______________________________
(Last 3 digits for Visa, Discover & Mastercard. American
Express is 4 digits on front of card.)
Signature:______________________________________________________
Card Bank Name_________________________________________________
