Order Form

Print and complete the order form and mail with full payment

(U. S. Postal Money Order or Certified Bank Check ) to

Dr. D. Bennerson, P.O. Box 2803, Frederiksted V.I. 00841-2803.

If you do not use the form indicate in a brief letter the product, description, quantity, color, size and any other details necessary and mail with full payment. You can also make contact by clicking the target to notify me of your order and payment in the mail or if you have any questions. Don't forget to include the cost of shipping and handling which should be $7.95 per order in the United States only. You should receive your order within two to three weeks.

Name______________________________________

Address____________________________________

City________________________________________

State/Zip Code_______________________________

Phone Number (_____)________________________

Item No.	Item Description	Color	Size	Quantity	Unit Price	S& H	Total Price







					Total	Order

For Office Use Only:

Pymt Recd ______CK______MO______Date Shipped______Comments______