Billing Address________________________________________________________________
_______________________________________________________________________
City________________________State______ZipCode__________Country________
Shipping Address_______________________________________________________________
_______________________________________________________________________
City________________________State______ZipCode__________Country________
Indicate if: ____Residental or ____Business address.
Phone(Home)_________________________(Work)__________________________
METHOD OF PAYMENT(check one):
Please charge to my   ____VISA;   ____MasterCard or   ____Discover
Signature of cardholder:__________________________________________
Date:________________
| For items $10.00 or less | $6.00 |
| For items >$10.01 to <$20.00 | $6.50 |
| For items >$20.01 to <$35.00 | $7.00 |
| For items >$35.01 to <$50.00 | $7.75 |
| For items >$50.01 to <$75.00 | $8.50 |
| For items >75.01 to <$100.00 | $10.00 |
| For items >100.01 to <$125.00 | $11.50 |
| For items >125.01 to <$150.00 | $13.00 |
| For items >150.01 to <$175.00 | $15.00 |
| For items >$175.01, multiple packages, over sized boxes, or international shipments | quoted individually |
| For 1 set of adjustable length or fixed length | $50.00 |