Card Style #	Single Card	Card Style #	Single Card
V 707		V 773
V 712		V 780
V 713		V 782
V 722		V 783
V 730		V 784
V 731		V 785
V 732		V 786
V 738		V 787
V 741		V 789
V 743		V 790
V 744		V 791
V 752		V 792
V 766		V 793
V 772		V 794
		V 795
Total Single Cards		Total Single Cards
Single Cards @ 2.00 each = Subtotal NY State Add 8.65% Tax Shipping & Handling in USA* Up to 20.00 total, add 4.50 20.01 to 30.00, add 5.50 30.01 to 40.00, add 6.50 40.01 to 50.00, add 7.50 *Please call for shipping outside USA. Grand Total

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Your Name As It Appears on the Credit Card

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Credit Card Expiration Date

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Address to Ship to if Different from Billing Address



Signature of Cardholder_____________________________________________

Please print and FAX us this form at 718-296-4977. Be sure to sign the form. If you do not have access to a FAX machine, you can use your FAX software and modem to FAX this form to us. If you don't have access to a FAX machine and your modem does not have FAX capabilities you may order by calling 718-296-4486 or mail your order to:


91-17 77th Street
Woodhaven, NY 11421

Please allow two to three weeks for delivery.