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ORDER FORM PAGE

ORDER FORM

Please ship the items listed below

Quantity @ $26.95
Name
Address
City, State, Zip
Phone
Fax
E-mail
Total Sale Price
Cr. Card Type
Cr. Card Number ( Insert First 8 Numbers, We Will Call Back For The Rest )
Expires




For Orders Paid By Check, Print This Form Out And Mail To The Address Listed Below. Do Not Click Submit.

Cummings Enterprises
175 Universal Drive N
North Haven, Connecticut 06473
Phone 203-645-5156
Phone 203-234-7547
Fax 530-452-1643
E-mail a39go39@yahoo.com
Online Info Request Form