Your Name:
Address:
City:
Apt.:
State:
Zip:
E-mail:
Item #1
Item Name:
Size:
Color:
Quantity:
Cost Each (include setup fees if any):
Total for Item #1:
Item #2
Total for Item #2:
Item #3
Total for Item #3:
Item #4
Total for Item #4:
Item #5
Total for Item #5:
Instructions:
Subtotal =
CA Sales Tax (if applicable) @ 7.25% =
Shipping & Handling =
TOTAL Due via PayPal