*Please print out this order form and fax or mail to us!
PLEASE PRINT CLEARLY

Date _______________ First Order_____ Re-Order_____

Business Name_________________________________________

Street Address__________________________________________
Address is:  residential home/office __    commercial office/store __

City____________________ State____________ Zip__________

Phone_______________________ Fax_____________________

E-Mail address_________________________________________

Person Ordering________________________ PO #___________

P.O.Box Mail Address___________________________________

Payment by Check_____________ Money Order______________
Payment by Credit Card : Visa____  MasterCard____
American Express_____     Discover/Novus_____

Account #(all raised print)_______________________  C.I.D. Code____

Exp Date___/___/___  Authorized Signature on Card_________________

Credit Card Bill to Address ___________________________________