PLEASE NOTE: IF YOU WOULD LIKE TO BE INVOICED USING YOUR VISA OR MASTERCARD, PLEASE NOTE HERE AND A CUSTOMER SERVICE REPRESENTATIVE WILL CONTACT YOU TO OBTAIN YOUR CREDIT CARD INFORMATION AND CONFIRM YOUR ORDER.

SOLD TO Your Name: Company: Address: City: State: Zip: Phone: Fax: E-Mail:

SHIP TO Your Name: Company: Address: City: State: Zip: Phone: Fax: E-Mail:

P.O.#	DATE	REQUESTED SHIP DATE

QTY	FIGURE NO.	DESCRIPTION	PRICE	DISC.