Billing Information (must match exactly with credit card):
* Required

- Name*
- Street Address*
- City*
- State/Province*
- Zip/Postal Code*
- Country*
- Day Phone No.*
- Night Phone No.*
- Fax Number
- E-Mail Address*

Shipping Information (if different from billing address):

- Name
- Street Address
- City
- State/Province
- Zip/Postal Code
- Country
- Day Phone No.

Method of Payment:

JCB Visa MasterCard American Express Discover

- Name on Card
- Account No.
- Expiration
- Bank Issuing Card

Items Ordered:

Item I
- Item No.
- Description
- Quantity
- Unit Price
- Item 1 Subtotal

Item 2
- Item No.
- Description
- Quantity
- Unit Price
- Item 2 Subtotal

Order Total
- Item 1 and 2 Subtotal
- Shipping, Handling and Insurance
- Sales Tax (Utah Residents Only - 6 3/8%)
- Order Total

Within the United States, add:
$7.95 for shipping, handling and insurance for orders up to $50.00.
$8.95 for orders $51.00 to $100.00
Add $ 1.25 for each additional $100.
$20.00 - Overnight for orders up to $100.00. Add $2.00 for each additional $100.00.

International, add:
USPS Express - $26.00 for shipping, handling and insurance for orders up to $100.00.
Add $4.00 for each additional $100. (Please allow 2 to 6 weeks delivery.)
May not be able to ship to some countries.

Please be sure an E-Mail Address and Phone Number is included on your order.
We use the United States Postal Service for all shipping.