
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Qty:___ Item _______________ Color ______ Size_____ Price Each: $ _______ Total $ Design: |
| Sub Total: $ |
| CA Residents, Please add 4.5% Sales Tax $ |
| Shipping & Handling $ |
|
S&H is: $3.50 for 1st item, add $1.50 for each additional item to the same shipping address. Figure S & H separately for each address we ship to. |
| Total Enclosed: $ |
| Credit Card # ________________________________________________ Exp. Date: ______________ |
| Name On Card: |
| Signature:: |
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| Company Name: |
| Name: |
| Address: |
| City/Providence: |
| State & Zip Code: |
| Country: |
| Phone with Area Code: |
| Fax with Area Code: |
| Email: |