Please provide the following ordering information:

QTY	DESCRIPTION

	BILLING Information
Purchase Order #

Name

	Billing Address (must be your credit card billing address)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

	SHIPPING (if not the same as billing)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Important for your security.

Do not add any credit cad number.

An invoice will be faxed or email to you, You will fill the card number on that invoice & fax it back to us.