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                               =$7.75

50.00 to 99.99                               =$9.75

100.00 to 149.99                           =$11.75

50.00 to 199.99                             =$13.75

200.00 to 249.99                           =$15.75

250.00 to 299.99                           =$21.75

300.00 to 499.99                           =$27.75

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:

(_____)______-_________________