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      ORDERING INFORMATION

  You can phone in your order or fill out the form below

First Name

Last Name

Address 1 

Address 2 

City State ZIP

Email Address

Daytime Phone#: Area Code -

Payment      ( AMEX Card ID# )

Credit Card # - - - Expiration Date /

Item #   Description   Qty

Item #   Description   Qty

Item #   Description   Qty

Item #   Description   Qty

                                          

Order Total   Up to         $7.00 $7.01       to $19.00 $19.00      to $35.00 $35.01      to  $50.00 $50.01      to  $75.00 $75.01      to $100.00 $100.01 and over
Shipping          & Handling    $5.50    $8.50   $10.50   $12.50   $16.50   $18.50   FREE