Order Form

*If you are interested in our products, services or have questions please call (972)989-6731 or Send e-mail to: classerv@flash.net


	Last Name

	First Name

	Address Line 1

	Address Line 2

	City

	Zip Code

	E-Mail Address


		State

Country

	Phone

Ship To Address Only If Different Than Above


	Name First and Last

	Address Line 1

	Address Line 2

	City, State, Zip Code

Desired Products
Ref Number Product Description Quantity Price

Subtotal of order shipping charge
Up to $15.00         $4.00
$15.01-$25.00       $7.00
$25.01-$50.00       $10.00
$50.01-$75.00       $12.00
$75.01-$100.00     $15.00
$100.01-$500.00   $25.00
Over $500.00         $30.00
For orders greater than $1,500.00 please contact for rate

Subtotal

*Shipping

Total

Experation (MM/YY)

Credit Card Number


	All orders will be verified before being processed