Name: _______________________________________________________________
Address: _____________________________________________________________
City: _______________________________ State: ______ Zip Code:______________
Area Code & Telephone: _________________________________________________
Area Code & FAX: _____________________________________________________
E-mail address: ________________________________________________________
_____ Quantity Ordered
X $50
__________ Total enclosed or charged to credit card
Please allow 2-3 weeks for delivery.
METHOD OF PAYMENT:
Checks, money orders, or PayPal.