Ordered By: (Please print CLEARLY!)
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Name: |
_________________________________________________ |
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Address: |
______________________________________________________________ |
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City: |
________________________ |
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State: |
________________________ |
ZIP: |
__________________ |
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Country: |
________________________ |
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Telephone: |
_________________________________________________ |
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Ship To: (If different then above)
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Name: |
__________________________________________________ |
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Address: |
______________________________________________________________ |
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City: |
________________________ |
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State: |
________________________ |
ZIP: |
___________________ |
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Country: |
________________________ |
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Telephone: |
__________________________________________________ |
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Payment Options: (Select One)
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Money Order (Amount): |
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VISA: |
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Expiration Date: (MM/YY) Security Code: _______(on signature Strip) |
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MasterCard: |
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Expiration Date: (MM/YY) Security Code: _______(on signature Strip) |
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Discover: |
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Expiration Date: (MM/YY) Security Code: _______(on signature Strip) |
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If paying by credit card, please sign below:
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Signature:_______________________________________ |
Date:______________ |
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Item # |
Description |
Color |
Size |
Qty. |
Unit Price |
Total Amount |
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*Shipping is based on order size and shipping method (Ground or Air)
You will be notified of the shipping charge before your order
is processed.
Boards require special rates, please call for details.
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Shipping & Handling* |
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Sales Tax (Florida residents only) |
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Grand Total |
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Contact Information: