

Order Form: Orders maybe Phoned, Faxed, Mailed or Emailed to Us.
Phone: 330-893-7000 Fax: 330-893-2810
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For Easy Ordering
Print and Mail or
Fax this form:
| Qty. | Item # | Description | Color | Price Ea. | Sub Total |
|---|---|---|---|---|---|
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| _____ | __________ | ________________________ | ___________ | ________ | ________ |
| Sub Total $ |
| Ohio State Residents add 6% tax. |
| Shipping/Handling - See Chart Below: |
| Total Enclosed: |
Payment Options: |
| Acct. # _________________________________ Exp. Date: ______ |
| Name on the Card: |
| Name: |
| Address: |
| City/Providence: |
| State & Zip Code: |
| Country: |
| Phone with Area Code: |
| Fax with Area Code: |
| Email: |
Thank Your For Your Order
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You May Phone, Fax, Mail or Email Orders.
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| Shipping and Handling Rates: |
| ......Up to $20.00 add $4.35 |
| $20.01 to $30.00 add $5.45 |
| $30.01 to $40.00 add $6.55 |
| $40.01 to $50.00 add $7.65 |
| $50.01 to $75.00 add $9.85 |
| .....Over $75.00 add $10.95 |
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