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Order Form

Please fill in all fields. If the e-mail submission does not work, please be so kind as to print the form and fax it to us at 516-489-0245.
Whether submitted by fax or e-mail, WE WILL REPLY BY E-MAIL and give you the final order amount (including shipping), and let you know if anything is not in stock.
PLEASE NOTE; WE SHIP TO U.S. STREET ADDRESSES ONLY; NO P.O. BOXES

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  • Please provide the following Billing Information. This should be the address your
    credit card bills are sent to.
    Name
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    FAX
    E-mail
  • Please provide the following ordering information: Be sure to fill in all the fields!
    Qty Part #
    Size (M,L,XL,XXL)
    		 Description Price each
    BILLING OPTIONS
    Credit card
    Cardholder name
    Card number
    Expiration date
    SHIPPING ADDRESS
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country

           

Copyright information goes here.
Last revised: November 01, 2004