Fax , Mail Order Form
Phone: 9.2.5-5.5.6-9.0.3.4
Mail: Send this form with your payment to:

Product #	Item Description		Price	Qty.	Total
Please add shipping charges from the table below (US only)				Shipping
$ 0.00 TO $9.99 add $ 4.85		$ 30.00 TO 49.99   add $ 7.99		Subtotal
$10.00 TO $19.99 add $ 5.99		$ 40.00 TO 99.99   add $ 8.80		Tax
$20.00 TO $29.99 add $ 6.99		$ 100.00 TO 999.99   add FREE		Total
Free shipping on orders $100.00 or more ( US only)

Shipping Address

Name
Address
Address 1
City		State.
Country		Zip
Email		Phone #
Comments

Billing Address
 Check if same as shipping address

Name
Address
City		State
Country		Zip
Phone #		Fax
Email

Billing Information

Credit card
Name on Card
Card number
Expiration