SECURED ORDER PAGE
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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 y
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 Three: fax us your order: 1. fill out the order form above using either your check
2. print out the form 3. fax it to us at 203-741-1040 (24/7, anytime)
(CLICK the Submit button, then please wait a few seconds for the page to upload)