Bill To:
Name______________________________________________________________________

Address____________________________________________________________________

City____________________________________________ State_____ Zip ______________

Provence_______________________________________ Country ____________________

Phone Number ______ - ____________________

Ship To (if different than Bill To):
Name______________________________________________________________________

Address____________________________________________________________________

City____________________________________________ State_____ Zip ______________

Provence_______________________________________ Country ____________________

Phone Number ______ - ____________________

E-Mail _________________ @ ____________________

Qty.	Description (style, color, etc)	Size	Price Ea.	Total
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
____	________________________________________	______	________	________
		Subtot.	$_______	$_______
		Ship.	$_______	$_______
		TOTAL	$_______	$_______

METHOD OF PAYMENT: (circle one)  VISA  MC AMEX 

Credit Card No._________________________________________ Exp. Date _______________

Signature (as appears on card) ____________________________________________________

______ Cashiers Check  ______ Money Order