NAME:____________________________________________

ADDRESS:_________________________________________

CITY:_____________________ STATE:______ ZIP:_________

E-mail address:_________________________PHONE #_______________




MODEL#      QUANTITY     DESCRIPTION          PRICE

_________|___________|_______________________|______

_________|___________|_______________________|______

_________|___________|_______________________|______

_________|___________|_______________________|______

_________|___________|_______________________|______


....................................SUBTOTAL  ______

.......U.S. SHIP & HANDLING..CALL FOR PRICING ______

......INT'L SHIP & HANDLING..CALL FOR PRICING ______

..........NJ Residents Include 6% Sales Tax . ______

........................................TOTAL . ______


CREDIT CARDS :  VISA        MasterCard      Discover


Card Number________-________-________-________ Exp ____ /____




SIGNATURE__________________________________DATE____________