Order Form

We Accept VISA, MasterCard, Discover & American Express

Please fill in all fields below to place an order. If a field does not apply leave it blank. After completing the form click on the submit button:

Name:
Company:
Address:
City:
State:
Zip Code:
Country:
Phone:
Fax:
Email:
Enter the quantity of the items you want to purchase. Leave the quanity box blank for the items you do not want to purchase:

QTY. PART NO. DESCRIPTION ($) PRICE
1745 Appliance Slippers (Pair)
(Plus Shipping & Handling: $11.50 per pair) 		56.00
MK-6 Red Pepper Spray (Delivered) 22.00
PAAL PAAL - Personal Attack Alarm (Delivered) 29.95
A-160 Home Security Monitor (Delivered) 350.00
I.D. 2000 Invisible Security Marker (Delivered) 6.95 (ea.)
3 for 15.95
BONA-WFC Bona Wood Floor Cleaner (Delivered)
Type: Laminate Wood 		32.95
ENVCOAT Envicoat clear protective coating (Delivered) 19.95

Add up the cost of all lines checked above. Add 8.25% sales tax if you are in the state of California; otherwise no tax. Be sure to add shipping and handling cost were applicable:
Sub Total:
Sales Tax (Ca. only):
Shipping & Handling:
Total:

Please enter your Credit Card information:

American Express Discover MasterCard Visa
Credit Card Number:
Expiration Date:
Customer Service 800 Number:
(on the back of the card)

Comments:

Please Review your entries before submitting them!

If you have any questions regarding the use of this form please send Email to: pg50verizon.netnet

Return to Main Page