*Grand Total includes $12 per $100 shipping as noted below.

order total	shipping
$0-$99.99	$12
$100 to $199.99	$24
$200 to $299.99	$36, etc.

Please allow approximately two weeks for normal order processing.

Once you have the GRAND TOTAL Above,
please complete the following information.

(All fields are mandatory except where noted)

Name
Shipping Address:
City:
State:
ZIP Code:
Email
Phone:
Fax (optional):
Store Opening Date:

Current customers may pay by VISA / MasterCard / AMEX
or continue to choose "Bill Me" option.
Bill me:

Pricing reflects a discount for cash/check purchases.
Credit card purchases are not eligible for
3% cash/check discount. 3% will be added to
your invoice if paid by credit card.

Enter Credit Card Number:
Enter Card Verification Code (3 or 4 digits on back):
Enter Expiration Date: