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For Secure Ordering Click Here!

      

        

          

            

          
          

            
 10051 Vistadale Dr.
Dallas, TX.  75238
214.341.3222 Phone
214.341.0673 FAX


          
        
      

Visa/Mastercard/Novus Discover/American Express. The material transmitted from this form is NOT SECURE or ENCRYPTED.
 

        

          
Terms
            and Conditions
 
        
        

          
All Payment must
            be in US Currency.  
 
        
        

          
You may print out
            the completed form and fax to 214/341-0673 (Phone/Fax) (For optimum
            printing, in "page setup" reduce to 80%)
 
        
        

          
Personal
            Information
 
        
        

          
All fields must
            be filled out for your order to be processed.
 
        
      

        

          
Order
            Date:  
           
        
        

          

            
Credit Card Billing Info:
          
        
        

          
Name:
 
          
 
          

          
 
 
        
        

          
Address:
 
          
 
          

          
 
 
        
        

          
City/State/Zip code
 
          
 
          
Country:
           
          
  
            
 
        
        

          
Phone
 
          
 
          
Fax
           
          
 
 
        
        

          
Email:
 
          
 
          

          
 
 
        
        

          

            Credit Card
            Visa
            MasterCard
            American Exp
            Discover
            
 
          
 #
 
          
Exp.Date:
           
          
 
 
        
        

          
Signature
 
          
 
          

          
 
 
        
        

          

        
        

          

            
Ship To:
          
        
        

          
Name:
 
          
 
          

          
 
 
        
        

          
Address:
 
          
 
          

          
 
 
        
        

          
City/State/Zip Code
 
          
 
          
Country:
           
          
 
 
        
        

          
Phone:
 
          
 
          

          
 
 
        
      

Please complete the bottom form. For larger or complex orders please contact us at or call us at Phone 214.341.3222.  Order Selection Description Qty. Unit Price Total    X   X    X    X   X   X   X   Sub total   Shipping and Handling     TX Residents add 8.25% Sales Tax   Grand Total

This Form is still under construction. You may fill in the form then print it to either fax or mail. If you have questions, .