850-670-8834

Mail-In Form

Please print this form and submit with your order. Allow 4-6 weeks for delivery.
For special delivery orders (overnight, etc.) please call us to inquire about these additional costs.

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Last Name:
First Name:
Street Address:
City:
State:
Zip:
Phone #:
Shipping Name & Address: (if different)
Cost per item:	$39.95
X Quantity:
Subtotal:
Tax: (Illinois residents only)	.0675
Subtotal:
S & H:	$4.95
Total: