Shopping Cart - Order Form
For First Time Buyers,

INSTRUCTIONS:

First Time Buyers: Fill In all fields marked with an "*", you only need to enter a shipping address if it is different than your customer address. (Note: We cannot save your shipping address.) We will send your permanent Customer Number on your shipping invoice.

After Credit Card Verification your order will be shipped as soon as possible. If there is a problem with the information, you will be contacted using the information we have on file.

Change your mind and want to add more items to your cart?
BEFORE You Fill Out This Form,
Click your Browser's "Back" button once to continue shopping.

 Your First Name*:
Your Middle Initial:.
Your Last Name*:

Your E-mail Address*:

Your phone number (including Area Code)*:
()- (Please Enter Digits only)
Street Address*:

Street Address 2:

City*:

State*:
Country Sorry, US Addresses Only
Zip Code*:
Don't forget your ZIP or Postal Code!


Shipping Address (If Different From Above):

If you would like your order shipped to a different address than the one above, fill out this section.

Ship to Name:

Street Address:

Street Address 2:

City:

State:
Country: Sorry US Addresses Only.
Zip Code
Don't forget your ZIP CODE!


Credit Card Information:
Credit Card*:
Credit Card Number*:

CVV Number*: What's This?
Card Holders Name (As it Appears On the Card)*:

Expiration Date:
Month*: Year*:


Finally, before you click the submit button, please tell us how you
found our on-line store:

Exit the Shopping Cart without placing an order......