Personal Information Please enter your Name and Address as they appear on your Credit Card Statement: First MI Last Company Address City State Zip Country How may we contact you if necessary? (Day Phone Required for Carrier) Day Hours: How did you find us? Night Hours: ("Yahoo", "Excite",etc.) E-Mail Credit Card Information To split charges across two cards: Card #1 Card #2 Expiration Date: Exp: Amt: Product Purchase(s) Qty Order# Description Each Total 1 2 3 Merchandise Total $ Processing Charge $ Subtotal $ Sales Tax (8.25% CA Only) $ 2nd Day Delivery $ Overnight Delivery $ Total Charges $