Bill To:

Name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
E-mail

Ship To: (if different from above)

Name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
E-mail

Please provide the following ordering information:

QTY	ITEM#	UNITS	DESCRIPTION	DSC%	PRICE	TOTAL
					Subtotal
					Tax
					Freight		See Below
					Misc
					Bal Due

Shipping:

Standard US Mail (may take 2-3 weeks within the USA)
If SUBTOTAL amount is:
$0.01-10.00 add $4.00
$10.01-20.00 add $5.00
$20.01-65.00 add $7.00
over $65.00 add 10%

Thank You!