***Mail order form only- NOT for online submission***

(This is an interactive form- Fill it out online, print it out, and then mail it to us!)

Customer Name: Email address:
Street Address: Phone Number:
Phone Number (#2):
City: State (abbr):
Please select payment type below: How did you hear about us? (optional)
A friend or family member
Saw it in a store
Internet search
Other source
*Note: Add two additional weeks shipping time for personal checks
**Note: When using credit, the following additional information is required:

Credit Card Information:

Type of card: Expiration date (Mo/Yr):
Name on card: Credit Card #:
Signature: Date:

Item Code Qty Description Unit Price Ext
Shipping(# of items) x ($4.50) =
TaxNM residents: Add 5.8125%

OK? Now You're Ready To Print!

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