Order Form

Order Form
You can also use this form to place your order without using our online shopping cart.
Simply fill up this form, print and fax it over to 1 (626) 334-0502.
We will contact you within 24 hours after we receive this form or you can call us at 1 (626) 334-0470.
Contact Information
Full Name:
Telephone Number:
E-Mail Address:
Address:
City, State and Zip:
Shipping Information  (leave blank if same as above)
Full Name:
Address:
City, State and Zip:
Order Information
Quantity Product Model/Description Price Total
Shipping Method:

USPS 2-3 Days Priority Mail

USPS Express

UPS

Sub-Total:
CA Sales Tax (9%):
Shipping Rate:
Shipping Insurance:
Total Due:
Name on Credit Card:
Credit Card Type:
Credit Card Number:
Expiration Date:
Comments
Prices subject to change without notice.
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