Order Form

Shipping Address:

Name:
Street:
City:
State/Prov. Zip/Postal Code:  
Country: Telephone Number:
Fax Number: E-Mail Address:    

Billing Address: (If different than shipping address)

Name:
Street: 
City: State/Prov:       
Zip/Postal Code: Country:           


Credit Card Information:

Credit Card Type:

Name on Credit Card:
Credit Card Number:
Credit Card Expire date (MM/YY)


Products Ordering:

Item #

Description

Quantity

Price

Total
         
         
         
         
         

   Sub Total:

  Shipping & Handling (See Below):

Tax: PA Residents add 6% (PA Sales Tax)

Grand Total:

Shipping Charges
(for Continental U.S. only)

$0.00 to $50.00

$8.00

$51.00 to $100.00

$10.00

$101.00 to $150.00

$14.00

$151.00 to $200.00

$16.00

Orders over $200.00 will be quoted in conformation.  
All orders will be insured