ORDER BY PHONE
Complete form & give information to  Customer Sales at   305-406-0148

 ORDER BY FAX
 Complete form below and Send By Fax to
  305-406-0146		 ORDER BY MAIL
Complete form & Mail to 
6842 NW 77 Court,
 Miami Florida 33166		 ORDER BY E-MAIL
Complete form below and send by 
 
 

ORDERED BY

SHIP TO
Name Name
Address Address
City/State/ Zip City/State/ Zip
Phone: (Required) Day(      )                             Evening(     )                        E-Mail
Your  phone numbers and e-mail are kept confidential and are used only in the event we need to contact you for security reasons in connection with your credit card or about your order.

 

ITEMS ORDERED
ITEM # PRODUCT DESCRIPTION QTY PRICE EACH TOTAL PRICE
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. . . . .
. . . . .
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. . . . .

 

 Sub Total

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PAYMENT METHOD

Sales Tax
 ( FLorida  Residents )
Check Enclosed Handling & Shipping  .
Money Order Enclosed TOTAL  DUE .
Master Card


Shipping Charges

$0 to $25   $5.95
$25.01 to $50 $9.95
$50.01 to $75 $11.95
$75.01 to $100 $14.95
$100.01 to $150 $17.95
$150.01 to $300 $19.95
$300.01 and up     $23.95 

Please add $15 to the standard shipping and handling chart for shipments to HI, AK, PR and USVI. 
For shipping outside U.S.A Please e-mail us for rates. 
Visa Card
Credit Card Number
Expiration Date on Card
Name on Credit Card
CARD HOLDERS SIGNATURE
To process your order, your Credit Card Name and Billing Address must match Name of person Ordering and Their Address as Above.