| 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 can only accept credit card & checks from the US. Customers from all other countries please make your payment with an International Money Order. | |||
| 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 contingous US States) | $8.00 | $10.00 | $12.00 |
| US Priority Mail ( PO Boxes only) | $12.00 | $12.00 | $15.00 |
| Alaska & Hawaii (UPS 2 Day Air) | $32.00 | $32.00 | $32.00 |
| UPS 2 and 1 Day Express (48 contingous US States) | See Chart | See Chart | See Chart |
| Alaska & Hawaii (UPS 1 Day Air) | $66.00 | $66.00 | $66.00 |
| Canada UPS Expres | $36.00 | $36.00 | $41.00 |
| PURCHASE INFO | ||||
| Product Code | Description Size/Color (if applicable) | Qty | Price Ea. | Total |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| ______ | _______________________________ | ____ | $_______ | $______ |
| Subtotal | $______ | |||
| Shipping Method | _______________________________ | Shipping | $______ | |
| GRAND TOTAL | $______ | |||