Phone:

SHIPPING ADDRESS Complete if  DIFFERENT  from  BILLING  address.

Name

Address:

E-mail:

City:

Address:

Company  Name (Optional)

Zip Code

State

PAYMENT INFORMATION

MONEY ORDER

(MAIL IN)

Order total:

WA State SalesTax: 8.2% (if applicable):

Express Shipping/Handling (if applicable):

10% discount for order more than $75.00

Order Grand Total:

Billing address same as shipping address?  YES        no

If  DIFFERENT, check NO  and complete Billing,  Shipping and Payment sections.

If SAME,  check YES and complete   Billing and Payment  sections.

Item #

Description

Quantity

Price

Line Total

First Name:

Address:

Phone:

E-mail: