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Item Total |
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Shipping |
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if C.O.D. add $5 |
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Total |
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Date of Order |
___________________ |
Date of Order |
___________________ |
Name |
___________________ |
Name |
___________________ |
Address |
___________________ |
Address |
___________________ |
City, St. Zip |
___________________ |
City, St. Zip |
___________________ |
Daytime Phone |
___________________ |
Daytime Phone |
___________________ |
METHOD OF PAYMENT
Certified Check, personal check, money order