Questions and Orders (Shipping Charges on Page 2 of this form):
1. Mail form below with order and payment
2. Fax your order 24 hours a day (302) 945-7800

Bill To:
Name______________________________________________________________________

Address____________________________________________________________________

City____________________________________________ State_____ Zip ______________

Phone Number ______ - ____________________

Ship To (if different than Bill To):

Name______________________________________________________________________

Address____________________________________________________________________

City____________________________________________ State_____ Zip ______________

Phone Number ______ - ____________________

Item#	Qty.	Description	Size	Price Ea.	Total
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
_____	___	________________________________________	______	________	________
			Subtot.	$_______	$_______
			Ship.	$_______	$_______
			TOTAL	$_______	$_______

METHOD OF PAYMENT: (circle one)  VISA  MC  Discover  AMERICAN EXP.

Credit Card No.____________________________________________ Exp. Date: __________

CV2 Code_______________ *Required (whats this?)

Signature (as appears on card) ____________________________________________________

______ Check (Please allow 2 weeks for check to clear)

______ Money Order