| QTY | ITEM # and NAME | PRICE | TOTALS |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| | | $ | $ |
| Add 4.5% tax - |
Shipping and Handling :
Minimum Ship Rate of $5.00 plus 6% of Cost of Order after $15.00
Shipping outside U.S. - please send an email for rates
|
Shipping & Handling | |
| TOTAL ORDER | |
| CREDIT CARD INFORMATION |
Name on Card -
|
Card Number -
|
Security Code 3 or 4 digit code on the back of card -
|
|
Exp.date CIRCLE ONE: VISA M/C
|
| CUSTOMER INFORMATION |
Customer Name
|
Address
|
City State Zip Code
|
Home Phone # Work Phone # Email Address
|
|