Please complete all sections of the folowing form.
First and Last name
E-Mail Address MUST ENTER
Street Address
City State/Prov. Postal Code
Country
Daytime Phone Number
FAX Number
How Would You Like To Pay For Your Purchase?
Method of Payment: VISA Master Card Discover COD (cash only)The is an extra charge of $5.00 for COD. COD is for use inside the USA only.
Card Number Expiration Date
Or call in you order 1-800-555-5678
What Would You Like to Order?
You must include for each item Quantity-Model/Reference No.- (One Item Per Line) Please cut and paste the item and price into the area area below.
How did you find our website? Search, Link, Use address from our print advertising, ..Etc.
How Would You Like Your Order Shipped?
Ground Shipping Can./U.S.(1-5 business days) $4.00 One Item $6.00 Two or more Items Air Shipping Can./U.S. (1-2 business days)$2.00 plus current UPS Air Service Charge AK,& HI -Surface (2-8 Weeks) $6.00 One Item $8.00 Two or more Items (11 lb max per package-larger orders must be shipped in multiple packages) Foreign (Other than Can./U.S.) Surface (4-10 Weeks) $6.00 One Item $8.00 Two or more Items (1-7 business days) $2.00 per package plus current Air Freight Charge
These Are The Terms And Conditions Of Your Order.