SECURE ORDER FORM

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Products You Would Like

QNTY PRODUCT PRICE TOTAL SUBTOTAL SHIPPING & HANDLING TOTAL

POSTAGE AND PACKING CHARGES (NOTE WE CAN NOT SHIP TO A PO BOX) CALL FOR FOR NEXT DAY SERVICE OR 2ND DAY SERVICE RATES

US POST OFFICE $8.00 for orders under $50.00 $12 for orders over $50.00 UPS INSURED $8.00 for orders under $50.00 $12 for orders between $50.00 and $100.00 $15.00 for orders over $100.00

METHOD OF PAYMENT

Credit card type Select Card Type From Drop Down List VISA MasterCard American Express Discover My Check Is being sent in the Mail Cardholder full name & billing address (if different from above) Card number (with dashes) Expiration date (mm/yy) CVN (Card Verification Number) This is the three-digit code located after the credit card number on the signature strip of Visa, Master Card, and Discover cards. American Express cardholders can locate a four-digit code on the front of the card above the account number.

Any Special Instructions?

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