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4 imple Online Order Form - Microsoft Internet Explorer JffJxJ

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4 imple Online Order Form - Microsoft Internet Explorer JffJxJ

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A43590B	3	5.00	15.00
|A49570H	l^1	127.95	27.95
Shipping and Handling (6%)			2.58
CA Residents Add 8% Sales Tax			3.44
Total Of Order			48.97

Payment Method

O Check (Click here for remittance address. Order will be shipped upon reciept of order. © Credit Card

If Pnying By Credit Card:

Card Type:    |visa    fil

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Card Wumber:

01/98

Expiration Datę (MM/DD):

Warne as it appears on card: |JohnDoeAverage jŚubmit My Order!! Clear Order Form

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