Email:
Billing Address :
NAME:
Address:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone:
Fax:
Shipping Address(Optional) :
NAME:
Address:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone:
Fax:
Shipping Method:
UPS Ground
UPS 3 Days
UPS 2nd Day Air
UPS NextDay Air
Fedex Saver
U.S. Postal Service
charge is
@ weight lb.
Special Shipping(Optional) :
No Special
MA Local Tax :
** No tax for shipping out of state.
Purchase Total =
$
(*Including shipping)
Taxable total: $ non-Taxable total: $
Payment Type:
COD
By Check
Company PO
American Express
Visa Card
Master Card
Enter a number:
Enter expiration date: Month
Year
Signature (for Fax only):____________________________________