Please provide the following ordering information:

QTY	DESCRIPTION                                                                      COST
	SHIPPING  AND HANDLING  UP TO 5 PIECES                                                           $3.50
	TOTAL AMOUNT
	CHECK OR MONEY ORDER NUMBER (VERY IMPORTANT)                                                                                     SHIP TO

Name

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
email