___ VISA ... ___ MASTERCARD

ACCOUNT #: __ __ __ __- __ __ __ __ - __ __ __ __ - __ __ __ __

NAME on CARD: __________________________________________________________

EXPIRATION DATE (MM-YY): __ __ -__ __

PHONE No: ( __ __ __ ) __ __ __ - __ __ __ __

EMAIL: __________________________________________

ITEM(S): __________________________________________________

AMOUNT(S): $ _____________

SHIPPING: $____________

CA TAX 7.25%: $ ___________ (on AMOUNT only not shipping)

TOTAL: $ ______________

Card ADDRESS & ZIP CODE: ________________________________

________________________________________________________

SHIPPING TO: ______________________________________________

__________________________________________________________

Date Needed by: _____________________

A Gift For : ______________________________Giftwrapped: Yes / No