P.O. Box 41734 Eagle Rock, CA 90041-0734 USA |
| Date_______________ Name__________________________________________________________________ Address________________________________________________________________ City ______________________________________ State _________ Zip ____________ |
| Item Description | Quantity | Price/Item | Total |
| Total | |||
| Postage or Shipping Charges | |||
| Handling Charge $5 for every order under $50 | |||
| GRAND TOTAL | |||