Date:

Sent By:

Name:

Day Phone:

Billing Address:

Evening Phone:

Fax:

City/State/Zip:

E-Mail:

Credit Card:

Delivery Address:

Expiration Date:

City/State/Zip:

Deliver By:

(   ) U.P.S. (ground service is standard)

(   ) Postal Air

(   ) U.P.S. 2 Day Air 

Country:

(   ) Surface Postal

(   ) U.P.S. Next Day Air

Delivery Phone:

(   ) Other:

Quantity Ordered

Quantity Shipped

Size

Color

Item

Unit Price

Total Price

Notes

U.S. Domestic Shipping/Handling* $5.00
U.S. 2-Day Air Delivery*
Domestic - Add $5.00
Alaska/Hawaii - Exact cost
U.S. Next Day Air Delivery -Exact cost
*Exact cost on heavy items
International Shipping - Exact cost plus $6.00 handling. Canada - Cost plus $3.00
Insurance
to $100.00 - $1.50
to $200.00 - $2.50
to $300.00 - $3.50
to $400.00 - $4.50
Over $400.00 - $5.50

Orders of 10+Dozens Discount Basic Shipping -$5.00

Sub Total

Air Shipment

C. O. D. – Not available

Cashiers Check / Money Order / Credit Card Ships immediately

Personal Checks Order Ships after check clears (12 Days Delay)

Insurance

ORDER TOTAL