| SHIPPING
INFO | BILLING INFO (fill in only if different) | ||
| Name | ____________________ | Name | ____________________ |
| Address | ____________________ | Address | ____________________ |
| Address | ____________________ | Address | ____________________ |
| City | ____________________ | City | ____________________ |
| State | ____________________ | State | ____________________ |
| Zip | ____________________ | Zip | ____________________ |
| Phone | ____________________ | Phone | ____________________ |
| ____________________ | ____________________ | ||
| CREDIT CARD INFO (if not paying by check or money order) | |||
| We accept credit cards, checks and money orders from the US, including APO/FPO's. We accept credit cards and international money orders from Canada and Puerto Rico. We do not accept orders from any other countries. | |||
| Card # | ____________________ | Exp. | ____________________ |
| Name on Card | ____________________ | Type | Visa Mastercard Amex (circle one) |
| CSC Code | ____________________ | What is a CSC Code? Visa/MC | Amex | |
| SHIPPING RATES | |||
| Method/Location | Orders up $20.00 | Orders $20.01 to $49.99 | Orders $50.00 & up |
| UPS Ground (48 Continental US States) |
$10.00 | $12.00 | $14.00 |
| US
Priority Mail (All 50 US States & PO/APO/FPO Boxes) |
$12.00 | $12.00 | $15.00 |
| More shipping options for Alaska, Hawaii, Canada, Puerto Rico and Express shipping choices See Chart | |||
| PURCHASE INFO | ||||
| Product Code | Description Size/Color (if applicable) | Qty | Price Ea. | Total |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| Subtotal | $______ | |||
| Shipping Method | _______________________________ | Shipping | $______ | |
| GRAND TOTAL | $______ | |||