Fax Order Form
USA fax (1) 610-546-1964

To fax your order then Print this page and send this form to the above number.

Price $
Shipping and handling  
Total US$  

All fields must be filled in for order to be processed
(BLOCK, capital letters please)

Name  _________________________________________________________________

Address  _______________________________________________________________

City ___________________________________________________________________

State  _________________ Postal/Zip ___________ Country  ____________________

Telephone _________________________ Email _______________________________

Credit / Debit Card Number:  (please write clearly)  


Card Verification Number ________ (Last 3 numbers on the back of the card)

Card type (Visa/Master)____________ Expiry Date___________ US$____________

Card-holder billing address if different from above, otherwise leave blank:




Signature ______________________________
Print this page

Allow up to 5 - 10 days for delivery
Fax the complete form to (1) 610-546-1964
Your payment receipt and order confirmation will be sent to your email address
Thank you for your custom!