SHIPPING INFO (No PO/APO Boxes)		BILLING INFO (fill in only if different)
Name	____________________	Name	____________________
Address	____________________	Address	____________________
Address	____________________	Address	____________________
City	____________________	City	____________________
State	____________________	State	____________________
Zip	____________________	Zip	____________________
Phone	____________________	Phone	____________________
Email	____________________	Email	____________________

CREDIT CARD INFO (credit card payments only!)
Card #	____________________	Exp.	____________________
Name on Card	____________________	Type	Visa Mastercard Discover (circle one)

SHIPPING CHARGES
UPS Ground		UPS 3 Day Select
$0.01-$30.00	$7.50	$0.01-$30.00	$13.00
$30.01-$60.00	$8.50	$30.01-$60.00	$17.00
$60.01-$10.00	$10.50	$60.01-$90.00	$21.00
Over $100.00	FREE	$90.01-$120.00	$25.00
		Over $120.00	20% of subtotal

PURCHASE INFO
Product Code	Description Size/Color (if applicable)	Qty	Price Ea.	Total
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
______	_______________________________	____	$_______	$______
				$______
		Subtotal		$______
Shipping Method	_______________________________	Shipping		$______
		GRAND TOTAL		$______

If there is not enough room on this form attached your own paper or use two forms.

You can fax this completed form 24/7 (Credit Card Payments Only) to:
281.292.0674