Internet Order Form

           Bill To:                                                                         Ship To:

                         Name of Person Placing This Order: 
                                                                                                                                                                                                                                                               Email Address:     Phone Number:  

                         Please enter our order for the following items from your catalog:

            Quan:   CU #:  Title:    
                                                     
                                                 
                                                     
                                                     
                                                     
                                                     
                                                     
                                                      

     List other information or special instructions in the space below:

 Your order will be shipped and billed within one or two business days.  We normally ship via FedEx
      Ground or UPS Ground unless otherwise specified.  Your order will be acknowledged and a Notice
         of Shipment will be sent to you via Email.

THANK YOU FOR YOUR ORDER!  YOUR BUSINESS IS APPRECIATED!