| SOLD TO (Name): | SEND TO:(If Different Address) |
| Preferred Customer ID: | Name |
| Address | Address |
| Apt | Apt |
| City | City |
| State/Prov. | State /Prov. |
| Zip/Postal Code | Zip/Postal Code |
| E-Mail Address | E-Mail Address | Phone | Phone | FAX | FAX |
|
Qty |
Stock # |
Product Description |
Color/Size |
Price |
Total Price |
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| Subtotal | $ | Enter Your Preferred Member ID:_________ | 10% Preferred Customer Discount | $ | Please Send Me Your Large Color Catalog | Add $5.00 | + |
| Please backorder out of stock items and ship when ready? ____Yes ____No |
Shipping* | + | Please Enroll Me In Your Preferred Customer Club | $20.00 Membership | + |
| Check/MO____ Visa____ Mastercard____ Amex____ Account No#:_______ - _______ - _______ - _______ Exp Date______ Signature:_______________________ |
Florida Residents add 7% Sales Tax | $ | |||
| OFFICE USE ONLY: Invoice:____________ Shipping Date:___________ |
TOTAL DUE | $ | |||