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Addr 2_____________________________________________________________________

City ____________________________________ State ____________ Zip _________

Daytime Phone ________________________ Evening Phone _____________________

e-mail ( please ) ________________________________________________________

Card _______ Card No. __________________________________ Exp Date ________

Name on card _____________________________________________________________

Billing Address ( Must be same as card ) _________________________________

Billing City ______________________ State __________________ Zip _________

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Item Description Amount from table below.

#____________ _____________________________________ __________ Ship By

#____________ Do Not use this form _____________ __________ UPS or USPS (post)

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#____________ _____________________________________ __________ Est. Amount(call us)

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Add 6% sales tax if shipping to Alabama __________

Estimated Shipping __________

Total __________

Prices subject to change! Valid through July 30, 2005