Order Form

Please Print Clearly Ordering Info: Name: _______________________________ Address:______________________________ City, ST, Zip__________________________

Ship to (if a different address): Name:________________________________ Address:______________________________ City, ST, Zip___________________________

E-Mail: _____________________________________________________________________

QTY	Description	Price	Total

Shipping & Handling Rates $1.00 to $7.99 = $4.95 $8.00 to $18.99 = $8.95 $19.00 to $56.99 = $10.95 $57.00 to $99.99 = $20.95 $100.00 and up = $29.95

Subtotal   AZ Tax if Applicable (.0785%)   Shipping & Handling   Subtotal   Less Coupon   Total Due

Thank You for Your Order!

Please make checks or money orders payable to:
Laurie Hallin
and send to Address at top