BILLING DETAILS:
NAME:_____________________________
ADDRESS:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Telephone:__________________________

Shipment Type: (check one)
USPS:______......Parcel Post:______......Other (specify):_______________
Payment Type:(check one)
Check:_____....Money Order:____ .......Credit Card:_____
Credit Card Information:
Credit Card Number:___________________________________
Expiration Date:____/____
Credit Card Type (Visa or Mastercard):_______________________

Cardholder's Name (as appears on card):__________________________________
Telephone #:____________________ (Required for all Credit Card Orders)

ITEM NUMBER:....DESCRIPTION:....................Quantity:.......Price (Each):
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add a separate sheet if you want more items:

Subtotal........................:____________
Tennessee Residents Add 9.75% Sales Tax:____________
$1 Insurance Addition (Optional):____________
Postage&Handling/Shipping Charge:____________*(see below)
TOTAL ENCLOSED..................:_________________

*United States Shipping Charges:*
Based On USPS (UNITED STATES POSTAL SERVICE) Cost:

UP TO $20.00 ------------- $6

$21 TO $40 ---------------- $10

$41 TO $100 -------------- $12

$101 TO $200 ------------- $15

Over $200 ------------------ add 8%

INSTRUCTIONS:
Fill out this form as correctly and clearly as possible to insure correct and fast delivery.
Visa or Mastercard accepted on orders of $25 or more.
Canadian and overseas contact us for shipping quote.
Only US Dollars accepted in payment.