To Place Your Order by Fax please print out this form and Fax it To:
(573) 624-3146 Missouri Residents please add 5.225% for Sales Tax to Total.

Quantity
Description Price Each
    $
    $
    $
    $
    $
    $
    $
    $
    $
 
Subtotal
 
 
Missouri Sales Tax (For Missouri Residents Only) 5.225%
 
Shipping For Orders over $100.00 free shipping  
     
  For Orders less than $100.00 please add $11.50 for Shipping  
 
Total
 
Name  
Billing Address:  
City

_________________________State:________________________Zip:____________
Phone Number: _____________________________Email:______________________________________
  Please Provide Us with either your phone number or email so if there are any delays or questions we may contact you.
Credit Card
(Visa___) (MasterCard___) Card Number____________________________________

Expiration Date (00/00)__________________________________________________

Verification Code (Only for Visa Cards)___________________
This is found on the back side of your Visa Card . Where you sign your name there is a long list of digits in the upper right hand side of the signature. We need the last 3 digits of the code.

Signature:____________________________________________________________
Ship To Address if different from the address above.

Name:_______________________________________________________________

Street Address:_______________________________________________________

City:________________________ State:______________ Zip:________________