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| Quantity | Item | Color | Design | S&H (see below) | Price Each | Total |
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| __________ | _______________ | __________ | __________ | __________ | __________ | __________ |
| __________ | _______________ | __________ | __________ | __________ | __________ | __________ |
| __________ | _______________ | __________ | __________ | __________ | __________ | __________ |
| __________ | _______________ | __________ | __________ | __________ | __________ | __________ |
| __________ | _______________ | __________ | __________ | __________ | __________ | __________ |
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Item #:__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
Item #:__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
Item #:__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
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Item #:__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
Item #:__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
Item #:__________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
| New York State residents add 8% sales tax |
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Shipping: $00.00 - $24.99 add $4.75 S&H $25.00 - $49.99 add $6.00 S&H $50.00 - $74.99 add $7.25 S&H $75.00 - $99.99 add $9.00 S&H $100.00 - $199.00 add $11.00 S&H $200.00 - $399.99 add $16.00 S&H Over $400.00... add $30.00 S&H The above rates apply to each address that is shipped to. |
| Total Amount Enclosed |
| Thank You For Your Order |
| _____ Check _____ Money Order |
| Name: |
| Address: |
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| Country: |
| Phone with Area Code: |
| Fax with Area Code: |
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