Please complete this page and fax or email to our office.

Customer Number (if known): 

Company Name (if new customer, please provide Tax identification number), Address, Phone & Fax Number:

Backorder requested:  [        ] YES             [         ] NO

Shipping options: We ship via UPS  [       ] Ground        [       ] 2nd Day Air          [       ] Next Day Air    

If you have your own UPS account, please enter it here:  __________________________________

Other Shipping Arrangements, please enter it here:  ______________________________________        

Purchase Order:   (All designs are pre-packaged 25 pieces per design).

Quantity (25 pieces per design minimum)      Design #                  Description                    Price

Method of Payment:    [        ] Visa         [       ] MasterCard          [       ] American Express

Name as it appears on the card:

Billing Address (if different from Shipping Address above)

Number of the card:

Expiration date of the card: 

Signature:

*Please note:  for in-stock designs, order are shipped within 24 hours.  For backorder items, please allow 2~3 weeks*