First Name:Last Name:

Billing Address	Shipping Address

E-Mail Address:

Daytime Phone Number:

Important: Upon submission of this order we will e-mail you a verfication number and the total amount of your order which will include $10 for shipping and handeling. You will receive this verfication generally within 24 hours of submission. Please wait for verfication from us before you make payment. This is to assure the item is on reserve for you.

Upon receipt of the verfication number please mail the check or money order including the verfication number:

Note: You will generally receive your item within 7 - 10 days of the date you mailed your check or money order to us. We will e-mail you verfication of shippment with a UPS tracking number upon shipment. If you do not receive your item within 14 days please e-mail or call us at 1-800-424-5353 and we will track your order.