mail order form to: |
or call us with order at: |
SHIPPING NAME AND ADDRESS: (P.O. Box holders please provide street address for delivery) |
PAYMENT METHOD: |
Name: | Please ![]() |
Street Address: | ![]() |
P.O. Box: | ![]() |
City: | ![]() |
State: Zip: | ![]() |
e-mail address: | |
Credit Card #:¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ | Daytime phone: |
Expiration date:¦ month: ¦ year: ¦ | |
Be sure to fill out entire card number and expiration date. | Evening phone: |
Signature, if paying by credit card: |
Quantity | Name / Item | Price per Item | Amount | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Sub Total | |||||||||||||||
Ohio Customers add 6.5% Sales Tax | ||||||||||||||||
Postage & Handling | ||||||||||||||||
Total |
We do not substitute unless you list a substitute: Do you have any substitutions? YES
NO