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Ship To:                                    Credit Card Billing:



Name   _______________________________   Name _______________________________



Street _______________________________   Street _______________________________



City   _______________________________   City   _______________________________



State  _______________  Zip __________   State  _______________  Zip __________



Phone  (______) ______________________	 Phone  (______) ______________________






		





Item         Description                        Quantity    Price Each     Total

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________|____________________________________|____________|_____________|_________|

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                                                  Merchandise Total ... |_________|

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                                              Shipping and Handling ... |_________|

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                                                              TOTAL ... |_________|

    					       



                                                               		SHIPPING & HANDLING

Money Order |__|  Check |__|		

Please Complete for credit card orders		              All Posted Prices Include

Master Card |__|   VISA |__|  American Express |__|	      Shipping and Handling Within

							      the United States.

Name      _______________________________________	      All International Orders

						                                Must Call for Shipping Rates

Card #    _______________________________________	      Prior to Ordering

				                                      Phone (800) 274-0675

Exp Date  ______ / ______		      

				                                 



Signature ________________________________________



                        Please allow 2-3 weeks for delivery