Order Form for Customers Using Visa or MasterCard
To use American Express or Discover Card,
please go back and use the PayPal order form.


Please provide the following ordering information:

Note:  DO NOT USE THE ENTER KEY (it will transmit this form prematurely).
Use Tab key or mouse to move from one space to another.

E-mail address (Very Important)

 

QTY ITEM # DESCRIPTION PRICE

 (Additional items can be entered in the comments box at the bottom of this form)

You are not required to enter the sales tax and shipping fields below- 
we can calculate these for you if you would prefer.

  Sales tax 8% of above total 

Only for shipments to California
 

ALL SHIPPING IS FULLY INSURED

Total special shipping charges
(if any) from item's description

Shipping charge from chart below

Leave this box blank- you do not pay this- if you have entered a special shipping charge above.   

SHIPPING CHARGE CHART

TOTAL MERCHANDISE AMOUNT  
Orders $99.99 and under $8.95
$100 - $200 $9.95
$200+   $10.95
Foreign orders $19.95 minimum

CUSTOMER INFORMATION
Credit card
Name on card
Card number
Expiration date
Enter month/year only, as in 05/02
CVVC number
  (These are the last three digits on
the signature strip on back of card)
Please make sure the address you input below matches
the address that appears on your credit card statement.
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone

SHIPPING ADDRESS - ONLY IF DIFFERENT FROM ABOVE
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
COMMENTS
(Is this a lay-away?  Do you qualify for a free offer?  Special Instructions?)
You may wish to print a copy of this form now for your records.  
Please click the button below to submit your order