Order Form
To place an order via fax; please print, fill-out and fax this order form to: 719-592-0931.

Quantity Product # Product Description Price (each) Line Total                                                                       Subtotal:   Shipping:   Sales Tax: Colorado Residents Only - 6.2%   ORDER TOTAL:

Shipping Information *First Name:   *Last Name:   *Address:   *City:   *State:   *Zip Code:   *Phone:   *E-mail:

Payment Information *Credit Card Type:   *Number:   *Name on Card:   *Expires:

Shipping Charges

Subtotal of Purchases	Shipping Amount
Up to $25	$4.95
$25.01 to $35.00	$6.95
$35.01 to $50.00	$7.95
$50.01 to $75.00	$9.95
$75.01 to $100.00	$10.95
$100.01 to $150.00	$12.95
$150.01 to $200.00	$14.95
$200.01 and over	$16.95