order form

ORDER FORM
TO PLACE AN ORDER ON LINE
This form works best with Microsoft Explorer.
It will also work in Netscape but comes out a little wierd.
YOU MAY ALSO PHONE US AT 760 320 4467

Name:

Postal Address:

City:

State and or Country:

Zip or Postal Code:

Phone Number:

Email:

If your UPS delivery address is different include it below.

Please Charge to my Visa MasterCard American Express

Credit Card Number:

Expiration Date (month and year):

My order is Retail Wholesale
Qty. Item Price Total

SHIPPING AND HANDLING FEES ARE BASED ON WEIGHT AND DISTANCE
Comments and Special Instructions

Name:
Postal Address:
City:
State and or Country:
Zip or Postal Code:
Phone Number:
Email: