Fill in the information below and press "SUBMIT" at bottom of page
Customer Information:


Customer Name:
Address:
City:
State:
Zip:
Telephone:
Fax:
E-mail:



If you're using Microsoft Internet Explorer Browser press the "Clear Form" first!

Order Calculator(Just a demo so have fun..!)
Enter Quantity desired..then Click on "Calculate Results"

Item
Quantity
Price Each

Amount
Item x
$2.35 Each
$
Item 2
$2.00 Each
$
Item 3
$3.00 Each
$
Item 4
$4.00 Each
$
Item 5
$5.00 Each
$
Item 6
$6.00 Each
$
Item 7
$7.00 Each
$
Item 8
$8.00 Each
$
Item 9
$9.00 Each
$
Item 10
$10.00 Each
$
Shipping: $0-$100   $5;  over $100 5% Total

$

SubTotal: $
The above amount is your total including shipping charges.
TAX TOTAL:
Sales Tax - Add 6.00% Tax.
Tax: $ $

Payment Options


You can phone in your card number. if you choose. (xxx)-xxx-xxxx
Pay by Credit Card (You can phone in this order!)
    Card: Card Number:
    Expiration Date:
We will call you to verify information.

Call(xxx)-xxx-xxxx
For Credit Card Order by phone.

Pay by Check

If by check, please send the total amount to:

Your Company
Your Address
Your City & State
Your Phone/Fax #'s

Check orders take two weeks to process.

Thank You For Your Order!