ORDER FORM

___________________________________________________________________
| QTY | ITEM NAME and DESCRIPTION              | EACH  |  TOTAL   |
|_____|________________________________________|_______|__________|
|     |                                        |       |          |
|_____|________________________________________|_______|__________|
|     |                                        |       |          |
|_____|________________________________________|_______|__________|
|     |                                        |       |          |
|_____|________________________________________|_______|__________|
|     |                                        |       |          |
|_____|________________________________________|_______|__________|

                                          PRODUCT TOTAL:  ________

               CALIFORNIA RESIDENTS ADD .0775 SALES TAX: (________)

                     (* see below) POSTAGE and HANDLING:  ________

                                            ORDER TOTAL:  ________

NAME  ____________________________________________________________

STREET ADDRESS  __________________________________________________

CITY  ________________________  STATE  _________  ZIP  ___________

PHONE  _______________________  EMAIL  ___________________________

PAYMENT METHOD:

 ____ check/money order enclosed  ___ Visa  ___ MasterCard  ___ AmEx
    
 Credit Card No. ____________/____________/____________/____________

 Expiration Date ____/_____   3 or 4 Digit Card Security Code ______

 Name as it appears on card: _______________________________________