Order Form

Order Information
Phone: (800) 521-6258
Fax: Print this form and fax it to (609) 397-5673
Mail: Call or e-mail for instructions and freight quote before sending order form by mail
Internet (Shopping Cart): If you would like to have us add this feature to our Site, contact us on our FEEDBACK form or call.

Terms & Conditions
We accept VISA, MasterCard or Discover

Shipping Information
Shipping cost based on actual package weight and method, as charged by Carrier

Order Form

Item #	Description	Price	Qty.	Total








			Subtotal
* Sales Tax (7%) for New Jersey Residents, or if Tax exempt supply NJ Tax ID # and Form			Tax*
Freight to be determined at time of shipping according to current Carrier rates. Please call for an estimate if desired.			Freight
			Total

Shipping Address

Name
Address
Address
City		State
Country		Zip
Email

Billing Address
Check if same as shipping address. If paying by Credit Card include address which Credit Card bills / statements are received at.

Name
Address
City		State
Country		Zip
Email

Billing Information
Do not Submit this form by E-mail with Credit Card #. Use only for printing & FAXing or e-mail without CC#.
If faxing you can fill out all fields on screen except CC #, print this form, then fill in CC # before faxing.

Credit card (VISA,M/C, DISCOVER, AMEX, PAYPAL)
Name on Card
Card number
Expiration	Security Code (3 digits from back)
Your telephone # (where we can reach you - daytime hrs.)
Notes or Special Instructions

FAX to: 609-397-5673