FAX ORDER FORM

DATE_______________________________

NAME:___________________________________________________________________

ADDRESS:________________________________________________________________

CITY:___________________________________________________________________

TOWN:_________________________________________________________________

STATE:_________________________		ZIP:__________________

HOME PHONE:(______)____________________WORK PHONE:(_______)______________________


	ITEM			QUANTITY                   PRICE
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

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			GEORGIA RESIDENTS ADD SALES TAX:______________________
	
							SHIPPING:___________________

							TOTAL:______________________

CREDIT CARD TYPE:__________________________________

CARD NUMBER:______________________________________________________________

EXP. DATE:__________________________________________

SPECIAL NOTES:______________________________________________________________

____________________________________________________________________________

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E-MAIL ADDRESS:_____________________________________________________________

SIGNATURE:__________________________________________________________________

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