To place your order, please Call, E-Mail, or Fax us to insure privacy & accuracy!

Please complete (Type or Write) this form, print for your records, sign, and then fax to:
(503) 213-5960
Please provide the following ordering information:

QTY:	DESCRIPTION (Please include Model Number, Size, Color, any accessory items, and Price):

	BILLING INFO:
*Credit Card:	VISA MasterCard Discover American Express Check-To Be Mailed
*Cardholder Name:
*Card Number:
*Expiration Date:
*Credit Card's Bill-To Address:
*Address (cont.):
Credit Card's Bill-To City:
Credit Card's Bill-To State:
*Credit Card's Bill-To Zip:
Signature:
Home Phone:
Work Phone:
Fax Number:
Country:
E-Mail Address:

* Required information if purchasing with a credit card.  The bill-to address must match the address on your credit card statement.

	SHIPPING INFO:
Ship-To Name:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Home Phone:
Work Phone:
Fax Number:
Country:
E-Mail Address:
Thank You Very Much- We Sincerely Appreciate Your Order!