Order Information:
- Unit Cost $75 each
- Michigan Residents Please Add 6% Sales Tax
- Shipping and Handling (See Below)
- Total

Shipping and Handling

Orders shipped to:

Continental US - US$5.00
Alaska, Hawaii, or Canada - US$10.00

Bill to Address:
- Name
- Street Address
- City
- State/Province
- ZIP/Postal Code
- Country
- Phone

Payment Information (Credit Card or Check):

Credit Card:
VISA Mastercard

- Credit Card #
- Name on card
- Expiration Date

Check:
- Check # (U.S. Funds Only)
- Name on Check

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Ship to Address (If Different than Bill To Address):
- Name
- Street Address
- City
- State/Province
- ZIP/Postal Code
- Country
- Phone

Message on Card:




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