Fax your order... anytime! (432) 550-4127
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We need information about you . . . E-MAIL Address: ________________________ |
Ship order to: (if different from your address) NAME__________________________________
DATE: ________________________________ |
| Item # | Qnty | Color | Size | D e s c r i p t i o n | Price | Extension |
| Merchandise TOTAL | |
| Shipping & Handling (See Chart Left) |
|
| Sub TOTAL | |
| Texas Residents ADD 8.25% Sales Tax |
|
| ORDER TOTAL |
|
U.S. orders Add |
Regular |
|
Up to $ 49.99 |
$ 9.00 |
|
$ 50.00 - $ 99.99 |
$ 10.00 |
|
$ 100.00 - $ 149.99 |
$ 11.00 |
|
$ 150.00 - Up |
$ 12.00 |
|
|
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We cannot accept COD orders
or Personal Checks.
Charge to:
[_] MASTERCARD [_] VISA
[_] DISCOVER [_] AMEX
Bankcard Number: ___________________________________
Expiration Date: ______________
NAME (On Card) _____________________________________________
BILLING ADDRESS ___________________________________________
City ________________________________ State _____ Zip __________
SIGNATURE ( Required ): _________________________________
(Form revised 5/8/03)