SHIPPING AND CONTACT INFO
Customer or Acct. Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Email Address
Phone Number

QTY	PLEASE ENTER DESCRIPTION and price

 

 If you are a retailer please enter the name of the sales rep. you have been working with in the space provided below:

Enter the date you would like to receive your order by in the space provided below. Please contact me if you are needing a large order in less than 4 weeks.

Please enter any special comments or /instructions in the space provided below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After submitting this you will receive an e-mail confirmation and invoice with shipping options.   Retailers please contact me if you need more info. about ordering.  I accept Mastercard, Visa, Paypal, checks and money orders.  You can either fax me or call me with your credit card info. as I am in process of setting up a secure shopping cart.