SECURED ORDER PAGE
DUE TO SYSTEM UPDATE YOU CANNOT PLACE YOUR ORDER USING THIS PAGE, BUT YOU NEED TO CLICK HERE TO CONTACT US
Place your Order here To Receive The Free Shipping.
This secured order page guarantees that your personal information will be safeguarded.
Do you want the Expedited Processing for $39.50? No Yes
If you want us to reserve our today's low price for you, and want us to charge your account and ship this product at a later time in the future, please take a note:
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Information about You as the Purchaser (shipping address may be different if wanted as shown on the next page)
Billing address
First name Last name
Street address City
State ZIP
Telephone with area code email (must have to receive confirmation)
Shipping address (leave blank if the same as the billing address)
Telephone with area code email
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Payment information choose one below
Option One: pay by check electronically Click here why!
Routing umber: (must be 9 digits)
Account number:
Confirm Account number:
Check number: (upper right corner)
Option Two: fax us your order:
1. Fill out the order form above
2. Print out this form
3. Fax it to us at 203-741-1040 (24/7, anytime)
Option Three: send your physical check or money order to
(CLICK the Submit button, then please wait a few seconds for the page to upload)