Please click "Submit" on the bottom of the page.

 

Information about you

Mailing address:

First name   Last name

Street address      City

State:                  ZIP

Telephone with area codeemail

Shipping address to be filled out if different

First name   Last name

Street address      City

State:                  ZIP

Telephone with area codeemail

 

Information about your payment

1/ Option One: electronic check

 
Bank Name:    
Bank Address: (state only)              

Routing umber: (must be 9 digits)                  

Account number:                               

Confirm Account number:                 

Check number: (upper right corner)                   

 

2/ Option Two: fax your check to: 1-203-741-1040

3/ Option Three: scan and email your check to:  omegastores@comcast.net

4/ Option Four: mail your check or money order to:

OMEGASTORES
314 Main St  #4572
Wallingford, CT 06492