First Name:        Last Name:   

Street Address:        Unit/Apartment/Suite:   

City:        State/Province:        

Zip/Postal Code:        Country:   

E-mail:   

Item #1        Item Price:   

Item #2        Item Price:   

Item #3        Item Price:   

Item #4        Item Price:   

Item #5        Item Price:   

SUBTOTAL PRICE (Excluding Shipping)   

How would you like to pay?    ** SELECT OPTION ** Personal Check Bank Money Order Western Union Layaway

Comments or Special Instructions?  Please use the box below:

IMPORTANT NOTE:  When you click "Submit", your order will be transmitted to us by regular e-mail.  We will then contact you to confirm your order, and provide details for remitting payment.  Please do NOT include credit card numbers on this form, as e-mail is not encrypted with SSL security technology.  Upon receipt of your order, we will:

1. Verify availability of the item(s)

2. Contact you via e-mail to confirm your order

3. Provide you with the total due including shipping

4. Provide exact payment instructions 

When you click "Submit", you will be returned to our home page.  THANK YOU!