QTY	Description
1 2 3 4 5 6 7 8 8
0 1 2 3 4 5 6 7 8 8
0 1 2 3 4 5 6 7 8 8
1	StandardPostage and Handling $6.00 Express Postage and Handling $9.00

 

Please charge my credit / charge card with the above amounts.

Payment Credit Card VISA MasterCard Bankcard Cardholder Name Card Number Expiration Date    (MMYY) CVV:     (Last 3 digits on signature strip)

Please provide the following contact information:

Full Name
Organization
Street Address
Address (cont.)
City
State/Province
Postal Code
Country
Work Phone
Home Phone
E-mail

 

	SHIPPING (if different from above)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Yes I require a TAX receipt for business.

• Please allow 7 days for delivery.