title

Order Form

TO BE USED FOR CHECK OR MONEY ORDER PURCHASES ONLY

Please provide the following contact information:


NAME:
ADDRESS:
CITY:
STATE:
ZIP CODE:
CANADA PROVINCE:
COUNTRY:
PHONE NUMBER:
EMAIL:
ORDER ITEM 1:		QTY:
ORDER ITEM 2:		QTY:
ORDER ITEM 3:		QTY:
ORDER ITEM 4:		QTY:
ORDER ITEM 5:		QTY:
ORDER ITEM 6:		QTY:
SUBTOTAL:
SALES TAX 5 PCT:
SHPG AND HDLG:
TOTAL:
REMARKS: