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SOLD TO:
First Name Last Name
Company Name
Street Address
City
State/ Province Postal/ Zip Code
Country
Phone Fax
E-mail (optional)
SHIP TO: IF DIFFERENT THAN ABOVE:
First Name Last Name
Company Name
Street Address
City
State/ Province Postal/ Zip Code
Country
Phone Fax
E-mail (optional)
CREDIT CARD PAYMENT METHOD
VISA MASTERCARD DISCOVER AMERICAN EXPRESS
Credit Card No.
Expiration Date: Month Year
Quantity Model Name Unit Price Total
Merchandise Total
CA. Resident Only:
Add 8¼% Sales Tax
Sub-Total
Shipping
Shipping Insurance
Grand Total

Delivery: 5 to 7 Days
Call or E-Mail for Express Mail
P.O. Box 44245
Van Nuys, CA 91412

Ph. (818) 894-0535
Fax: (818) 894-6516
E-mail: aaim@earthlink.net