Mail to: 1249 South First Street, San Jose, CA 95110
Or Call: 925.820.2628
| Method of Payment: | Ship To:(If different from billing address) |
| Check or money order ___ | Name___________________________________ |
| Visa ___ Master Card ___ Discover___Amex___ Exp. Date _______ 3 digit Security Code on rear Sig. Strip_______ | Street Address____________________________ |
| Name as it appears on Credit Card: _______________________________ | _______________________________________ |
| Address ________________________ | City ______________ State ____ Zip _________ |
| ________________________________ | Shipping Phone ___________________________ |
| City ______________ State ____ Zip _______________ |
|
| Account # ____________________________ | |
| Signature _____________________________ | |
| Description | Size | Color | Qty. | Cost | Total |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| ______________________________________ | ______ | ______ | ______ | ________ | __________ |
| Merchandise Total | __________ | ||||
|
8% Sales Tax for CA deliveries |
__________ | ||||
| Shipping (call for shipping charges) | __________ | ||||
| Total Enclosed | __________ | ||||
* Due to a large volume of fax-spam, we have our fax turned off, so please call us first at 295-2628 so we can turn it on for you