Ship To Address:

NAME:________________________________________________________________________

COMPANY:_____________________________________________________________________

STREET:______________________________________________________APT#____________

CITY, STATE, ZIP CODE:_________________________________________________________________

PHONE (Area Code): ____________________________E-MAIL:_______________________

QUANTITY OF SETS:_______________________

FEDERAL EXPRESS OR
OTHER COURIER SHIPMENT:___________________________________________________
(Fee must be included)

For orders within the United States and Canada, send check or money order $55.00(US)

For orders outside the United States and Canada, send check or money order $55.00 (US) plus additional money for postage (FEDEX or DHL for a 1 kilogram package)

AMOUNT ENCLOSED:_________________________

Mail Order Form To: