Bill To:
First Name		Last Name
Company Name
Address		Apt#
City		State
Zip		Country
Tel		Fax
E-mail

Check here if Bill and Ship are Same:

Ship To:
First Name		Last Name
Company Name
Address		Apt#
City		State
Zip		Country

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Qty	Item Description	Price	Total
	Subtotal
	Sales Tax (N.Y. only) + 8.625%
	Shipping Standard UPS / included Next Day Air / + $30 2nd Day Air / + $20 3rd Day Air / + $10
	Total

Shipping Options:
Next Day Air / + $21
2nd Day Air / + $10
3rd Day Air / + $5

IMPORTANT NOTE:
All prices include Standard Ground Shipping for Continental U.S. only.
For Alaska, Hawaii, and Puerto Rico you must add Air Delivery Rates.
For International orders and all others, please inquire.

How will you be paying?
Visa Mastercard American Express

Credit Card # Expiration Date


Is this your first order? Yes No

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