YOUR PERSONAL INFORMATION
BILL TO:
(Is this the same as your ship adr?)
NO
YES
Name:
Company:
Street:
Address#2:
City:
State/Prov:
Zip:
Country:
Tel:
(Needed to contact you about order)
CONFIRM ORDER TO:
(Needed if you want confirmation)
E-Mail:
Tax
$
Shipping Cost
$
Total Cost of your order:
U.S.$
SELECT A PAYMENT METHOD AND "Check Order".
I WILL PAY BY:
SELECT METHOD
On Account
By Credit Card On Line
By Credit Card Off Line
By Check
By Money Order
By C.O.D., N/A
These instructions will appear on your purchase order copy. To review and send your order, click "Check Order".