1.Fill In the fields below with the appropriate information
2. Proofread what you have entered, paying especially close attention to credit card numbers and e-mail addresses.
3. Click the "Submit" button below the form.
4. If you are a repeat customer please let us know in the designated area below.
Buyer Information Form
Have Your Ordered With Us Before? If you have, please Check This Box
And enter your customer number if you know it here
- First Name
- Last Name
- Billing Address (if paying by credit card, this is the address to which your credit card bills are sent)
- Billing Address
- City- State
- Zip/Postal Code
- E-mail Address **Required**
- Phone (home)
- Phone (office)
Ship- to Address if different, ( Please note that if you are charging this order, we ship only to your billing or work address - (this is to protect against illegal use of credit cards!)
Items Ordered -Please Fill Out Completely
Extra Text Fields For Your Use - Please Specify Expedited Shipping Here If Desired