2700 E. Patrick Lane, Suite 20
Las Vegas, NV 89120
Phone: (702) 262-7946
FAX : 702-262-9613
Print this form for fax ordering or mail ordering by check. Please fill in the information and send your check to the address above with a copy of this order. Money orders and cashier checks will be shipped immediately. Personal checks will be held for clearance of funds 7-10 days before shipping.


ORDER FORM

Item #1

Name of item: __________________________ Color: _______________

Size: _______________ Width (if applicable): _______________

Quantity: _______________ Price: _______________

Item #2

Name of item: __________________________ Color: _______________

Size: _______________ Width (if applicable): _______________

Quantity: _______________ Price: _______________

Price: _______________

Item #3

Name of item: __________________________ Color: _______________

Size: _______________ Width (if applicable): _______________

Quantity: _______________ Price: _______________

Item #4

Name of item: __________________________ Color: _______________

Size: _______________ Width (if applicable): _______________

Quantity: _______________ Price: _______________

Item #5

Name of item: __________________________ Color: _______________

Size: _______________ Width (if applicable): _______________

Quantity: _______________ Price: _______________



TOTAL

Total of order: _______________

Tax (if Nevada resident - 7.25%): _______________

Shipping: _______________

Grand total: _______________
SHIPPING INFO

Name on card: _______________________________

Address #1: _________________________ Address #2: _________________________

City: __________________ State/Province: ______ Zip Code: __________

Daytime phone: ________________________ Evening phone: _____________________

E-mail: _______________________________

PAYMENT INFO

Please check one of the following:

___ Visa ___ Master Card ___ Disover
Credit Card #: _________________________________________

Expiration Date: ____ / ____
(MMYY) Example: 08 01

CVV #_______(the last 3 numbers on the back of the card where you sign your name)

Name on card: _______________________________

Address #1: _________________________ Address #2: _________________________

City: __________________ State/Province: ______ Zip Code: __________

Daytime phone: ________________________ Evening phone: _____________________

E-mail: _______________________________

Is the shipping address the same as the billing address:

_____ Yes _____ No

Shipping method: ____ Regular | _____ One-day | _____ Two-day | _____ Three-day


Fax number (for confirmation): _______________________________

How did you hear about us?: ________________________________ (specify search engine)