Please provide the following contact information:

Name
E-mail

Please provide the following ordering information:

QTY	DESCRIPTION                                                       PRICE

                                                                TOTAL:

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

SHIPPING:
$5 to $20 =  $5
$21 to $50 =  $6                                            ADD SHIPPING FEES:
$51 to $80 = $8
$81 and up = $10

NYS add sales tax 8 1/4%                    ADD SALES TAX:
                                                                                  TOTAL:

MAIL CHECK OR MONEY ORDER FOR TOTAL ORDER TO:
 C. Richards
 124 Brookside Avenue
 Staten Island, NY  10314
DELIVERY IN 3 - 5 DAYS