Sold To: (If paying by credit card, note your name and address as it appears on file with your credit card company.
Name:_________________________

Address:_______________________

______________________________

City:__________________________

State:_______Zip________________

Ship To:  Please fill in information below if items are to be shipped to an address other than "Sold To" address.
Name:______________________

Address:_______________________

______________________________

City: __________________________

State: _______Zip:_______________

Items Ordered:

Item #          Qty              Description                      Price Each              Total Price
__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Method of Payment (No Cash or Stamps)
Reminder:  Make certain that your billing name & address above are the same as the name and address on file with your credit card company. 
Circle One:

Visa                  MasterCard                Discover

Credit Card Number:_____________________

Expiration Date:______________

Signature:  ____________________________

Daytime Phone: (        )  ________________

Order  SubTotal: _________

Shipping: _______________

Total: __________________

(We will notify you of shipping & Handling Charges after you place your order.)