Please write in your name & address below:

NAME

ADDRESS

CITY                                     STATE           ZIP

PHONE

E-MAIL ADDRESS

Ship to a different address:

NAME

ADDRESS

CITY                                   STATE            ZIP

PHONE

E-MAIL ADDRESS

MERCHANDISE TOTAL __________

SHIPPING CHARGES __________

**LESS GIFT CERTIFICATE(S) __________

SUB-TOTAL __________

 7% TAX FL RESIDENTS ONLY __________

 TOTAL ENCLOSED __________