PRINT ORDER FORM AND FAX TO 619.442.3460

FIRST                                       LAST     IF DIFFERENT FROM BILLING ADDRESS Name: Ship To: Attn: Attn: Address: Address: City: State: Zip: City: Daytime Phone: State: Zip:     FAX: 619.442.3460 E-Mail:

Quantity Description Unit Cost Total Price                                                                                         Payment: _____ MC     _____ VISA     _____ MONEY ORDER     _____ CHECK Charge# __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Exp. Date: __ __ - __ __        Secret Code __ __ __ (three digits on back of card ) PRINT Card Holder's Name: __________________________________ Signature: _________________________________________________ Sub-Total   Shipping     7.75% CA tax (if applicable)   TOTAL