Fax Order Form send to (1) 610-546-1964

Print this page and send this form to the above number

Price  $
Shipping and handling
$ 12.95
Countries outside USA/Canada/Europe/Australia/NZ:
Please add US$10.00 postal insurance to cover against lost/damaged goods. We cannot replace or refund your order unless this insurance is added to your total payment.
(Only applicable OUTSIDE USA/Canada/Europe/Australia/NZ)


All fields must be filled in for order to be processed (BLOCK, capital letters please)

Name  ________________________________________________________________

Address _______________________________________________________________

City ________________________State  ____________ Postal/Zip ________________

Country ___________________

Telephone _____________________Email ____________________________

Card Number:____________________________________________________

Card Verification Number ___________(last 3 numbers on the back of the card)

Card type (Visa/Master) ___________Expiry Date_________US$___________

Card holder billing address if different from above, otherwise leave blank:



Signature ___________________________________ Print this page

Fax this form to 610-546-1964 - Your payment receipt and order confirmation will be sent to your email address. Allow up to 5-10 days for delivery. Thank you for your custom!