Mail Order Form

To order from our catalog, please print out the form below,
then fill it out and mail or fax it to us.
FAX: 510-527-7718

Qty.

Description

Price Each

Total

           
           
           
           
           
           
           
           

Amount    
CA Delivery Add Sales Tax

 

 
Packaging and Insurance

2

00
Shipping Charge 15% of Amount ($6.00 Minimum)    
Total Enclosed with Order    
Payment Method:
 Check/Money Order or Credit Card: Visa / Mastercard / Discover
Card Number: ______ - ______ - ______ - ______ Expiration Date ___ /_______
Signature_________________________________ Date___________

E-mail and Phone Number:
(so we can contact you if there are any questions regarding your order)
E-mail address: _________________________________________
Phone: (home) _________________ (work) __________________

Mailing Address:
Name:___________________________________________________________________
Address:_________________________________________________________________
City: _______________________________  Zip: ______________

Shipping Address: (if different from above)
Name:___________________________________________________________________
Address:_________________________________________________________________
City: _______________________________  Zip: ______________