Order

Billing Address

Name:
Address:

City:
State:		Zip:
Phone:
Email:

Shipping Address

Enter shipping address if different from the billing address.

Name:
Address:

City:
State:		Zip:
Phone:

Order

Qty	Description	Price	Total
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Sub Total
Tax (Ohio customers):
Shipping and Handling
Order Total:

Shipping and Handling

Orders up to		$15.00 add	$6.00
Orders from	$15.01	to $25.00 add	$7.00
Orders from	$25.01	to $35.00 add	$8.50
Orders from	$35.01	to $45.00 add	$10.00
Orders from	$45.01	to $60.00 add	$11.50
Orders above	$60.00	add	$13.00

Credit Card Payment

If ordering by credit card, please provide the following information.

Card Company:
Card holder name:
Card #:
Expiration Date(mm/yy):

Complete Order