Please complete this form and fax it to us at 740.857.1990 
Or call us with your order at 740.857.0000!

Bill to:

Name:  ______________________________________ Phone # __________________

Address: _______________________________________________________________ 

Credit Card # _____________________Type: ___________ Expiration Date: ________ 

Time and Date for Return Call * _____________________________________________

* If you do not wish to give a credit card number on this order form, please give a time and date you would like to be called back (at given phone number) to provide this information. Please your include time zone (e.g. EST is Eastern Standard Time zone).


Order Products:

Send to :

Name: __________________________________________________________________

Address:_________________________________________________________________

City, State, Zip:____________________________________________________________

Message:________________________________________________________________

Deliver by:_______________________________________________________________
 

Shipping plus handling will be added to your product order.

We ship using 2 day ground delivery on Monday through Wednesday only to insure our products get to you as soon as possible.