ORDER FORM

Company:________________________                   Tel:________________

Contact Person:____________________                  Fax:________________

Ship Address:_____________________                  Date:_______________

_______________________________

  Quantity Description Price Extend
1        
2        
3        
4        
5        
6        
7        
8        
9        
10        
11        
12        
13        
14        
15        
16        
17        
18        
19        
20        

Payment Method: (Please check one)

Visa & Master Card: COD Money Order:: On Account:

Credit Card Information:

Card#:__________________________________ Exp.: ___/___

Card Holder:__________________________ (Please Print)

Ship Via: (Please check one)

U.P.S. Ground:___  3 Days Select:___  2nd Day:___  Next Day:___

U.S. Postal Services (International customer only):___

Please print, fill out and fax to 212-685-3327