Name		Organization
Street address		Address (cont.)
City		State/Province	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip/Postal code		Country
Work Phone		Home Phone
FAX		E-mail

QTY	ITEM #	DESCRIPTION	PRICE EACH	TOTAL PRICE
		Sub Total
		New York Sate Residents add 8.25% sales tax
		Shipping and Handling (see below)
		TOTAL DUE

Shipping and handling charges for United States.    International orders please call for shipping charges

Items	Add
1 item	$8.00
2 items	$8.50
3 items	$9.00
Each additional item	add 50 cents

BILLING	Visa Master Card Check Money Order Certified Check
Cardholder name	Card number  Exp date

SHIPPING	Write SAME if same as above
Street address		Address (cont.)
City		State/Province
Zip/Postal code		Country