Fax your order to us Free

If you prefer not sending your information over the Internet, you can print  this form and fax your order to us at:

Toll Free Fax number for placing your order.

    Quantity 

(please  observe minimums)

    Product Code #     Item Description   Unit Cost (ea)  Total for this item
         
         
         
         
         
     

 Sub-Total

  

 10% Discount on Orders Over $200

Shipping Cost (below)

  

      Billing Information

Shipping Information

                    Total

  

                 Shipping 

Name as  on Credit Card:


_____________________________

Credit Card Number:
_____________________________

Expiration Date:
_______/_________________
Address as appears
on Credit Card Statement:

St.___________________________

Town_________________________

State_________________________

Zip___________________________

 Address for shipping if different.


St.__________________________

Town________________________

State________________________

Zip_____________________

Email:
_____________________________

We will email you the UPS Tracking # upon Shipping. Normal shipping within 1 to 3 business days.

   Rates

If your SubTotal is:              Shipping Chg is:

$1.00 to 49.99                               =$7.25

 50.00 to 99.99                              =$9.25

100.00 to 149.99                           =$11.50

150.00 to 199.99                           =$13.50

200.00 to 249.99                           =$15.75

250.00 to 299.99                           =$21.50

300.00 to 349.99                           =$23.50

350.00 to 399.99                           =$26.25

400.00 to 449.99                           =$29.75

450.00 to 499.99                           =$33.25

All orders over $500 are FREIGHT FREE

If you don't need a confirming fax uncheck here. Please fax me confirmation of this order to:

(_____)______-_________________

 

 

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