ORDER CONFIRMATION FORM

SHIPPING ADDRESS:
NAME:     
ADDRESS:
CITY:           STATE:  ZIP:      
PHONE:        FAX:  
EMAIL (please type full address):            

BILLING ADDRESS(if different from shipping):
NAME:     
ADDRESS:
CITY:           STATE:  ZIP:      
PHONE:        FAX:  
EMAIL (please type full address):        

CHOOSE SHIPPING OPTION:    
UPS Ground     UPS Ground Residential   UPS 2nd Day Air
*Please note UPS does not ship to PO boxes
             











CHOOSE PAYMENT METHOD:   VISA   MASTERCARD  
CARD NUMBER:   EXP. DATE:

*PLEASE NOTE: We will contact you before processing your order with final total of order
 including shipping charges and tax if applicable.

Any questions or comments: