1. DELIVERY ADDRESS

2. ITEMS TO ORDER

*  We will e-mail or phone you to confirm your order and to inform you of the shipping & handling and total charges once we receive your submitted form.

Visa	American Express
MasterCard

Credit Card Number  

Holder's Name as Printed on Credit Card  

Holder's Phone # if different from Contact Person 

Expiration Date (MM/YY) 

Credit Card's Billing Address (This is the address where you receive your credit card statements.) (Very Important!)

same as shipping address

different (Street Number & Name/ZIP) 

Is this credit card a corporate, government or personal  card?

If your credit card was not issued in the U.S., please provide the following info about the bank that issued it.**

Bank Name  

Bank Telephone Number  

 
**  There is a 3% (minimum $5.00) surcharge for international credit cards.

Domestic U.S. Order (pick one):

UPS/FedEx Next-Day	UPS/FedEx 3-Day
UPS/Fedex 2-Day	UPS/FedEx Ground (48 states only)

International Order (pick one):

FedEx International Economy or UPS Expedited (3 - 7 business days)

UPS/FedEx Express (2 - 3 business days)

UPS/FedEx Ground (Canada Only, 4 - 7 business days)

US Postal Air Mail (? days.)  ** Please bear in mind that postal air mail involves two countries' postal systems and in case of a mishap, your package, although insured, may take weeks, or even months, to track. By requesting this less expensive postal mail delivery, the buyer will be responsible for the possible delay or loss).

If you have your own account number that you would like to use, please provide it in the appropriate space:

UPS 

FedEx 
 

*  We will e-mail or phone you to confirm your order and to inform you on the shipping & handling and total charges once we receive your submitted form.