| Sold to: | ||
| Address: | ||
| City: | State: | Zip: |
| Telephone: | Date: | |
| Quantity | Item No. | Description | $/Unit | Amount |
| Card No.__________________________ Three-digit Security Code number _ _ _
(found on the back of your card in the signature section) |
Sales Tax* | |||
| *MO residents add 7.6% tax | ||||
| Card Holder__________________________ | Ship./Hand. | |||
| Shipping to customers outside the US, NOT including Canada or Mexico: We charge whatever the actual postage is, plus $1.25 per package for handling. |
Up to 5.00 is now 2.25 5.01 - 30.00 is now 4.75 30.01 - 70.00 is now 6.50 70.01 - 120.00 is now 8.25 121.00 & up is now 9.75 |
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| Signature______________________________ | Total Order | |||