We use the following information to calculate your total shipping costs, and so that we can contact you with that information. We do not share or sell any of the personal information you give us with any outside parties. This information will be used to help you to place your order only.

You can print this form and send it to us via postal mail, fax, or if you'd like to simply send us the required information vi a email you can. We will usually get back to you within 24 hours of receiving your order request.

Business Contact Information:

Your Name:____________________________________________

Would you like us to call you? If yes: Contact Phone Number:_(______)______________

Business Name: __________________________________________________________________

Business Address: ________________________________________________________________

Is this a commercial address? Yes No Do you have a wholesale buyers License? Yes No

Email address: ___________________________________________________________________