Customer Information Name:___________________________ Phone:____________________ Email:___________________________ Address___________________ City:___________ State:___ Zip:______ Credit Card:MC V ______ ______ ______ ______ Exp. Date: ___/___ USA orders only ________________ We thank you for your order! Product Item Price Quantity Total Cost ___________________________ _____ _____ _______ ________ ___________________________ _____ _____ _______ ________ ___________________________ _____ _____ _______ ________ ___________________________ _____ _____ _______ ________ ___________________________ _____ _____ _______ ________ Shipping and Handling 6.50 6.50 Total Order: ________ Comments: