Order Form

Ship To: Email:

Bill To: Phone Number:

Order Date		Check #		Tax Exempt?
Will you accept backorders?		Amount Enclosed		Exemption #

Product #	Title	Qty	Unit Cost	Total Amount

Subtotal
Orders under $75.00 add shipping charges
6% Sales Tax (PA residents only)
Total Amount Due

Shipping Charges:
Orders totaling $1 - $10.00 add $5.75 shipping
Orders totaling $10.01 - $20.00 add $7.50 shipping
Orders totaling $20.01 - $30.00 add $9.50 shipping
Orders totaling $30.01 - $40.00 add $11.50 shipping
Orders totaling $40.01 - $60.00 add $11.50 shipping
Orders totaling $60.01 - $74.99 add $12.50 shipping

Please note: We charge a $30.00 fee for returned checks.