Name :

Shiping Adress :

City :

State :

Zip Code :

E-Mail :

Phone # :

# Of Stands : At $79.00 each (Add S&H).

Shiping (1-2 stands $19.00, 3-4 $38.00, etc.):

Total :

Method of Payment :

Check

Money Order

Credit Card

Visa :

Master Card :

Discover :

America Express :

Card Number : - - -

Experation Date : 1 2 3 4 5 6 7 8 9 10 11 12 / 2000 2001 2002 2003 2004 2005 2006 2007

You can send this to us by e-mailing it (clicking on the submit button), or print it out and Snail Mail or Fax it to us (Fax and Snail Mail can be found at the bottom of the page).

Fax - (541) 484-4973

Snail Mail - 645 Powers, Eugene Or 97402

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