Please fill out the form below and we will contact you by phone to confirm and process your order. A valid credit card will be required when confirming your order via phone. A $20 cost per card along with a $4 shipping and handling fee (per shipping address) will apply.

CARD(S) REQUEST FORM
Product Name	Quantity	TOTAL
Card (offered to the public at large ($20 each)		$
Shipping and Handling fee		4.00 $
TOTAL		$

CONTACT INFORMATION
Please enter your billing information below.
Your Name: (First/Middle/Last)
Email Address: **Avoid using free email accounts.
Shipping Address
Address:
City, State, Zip:	Select a State AlbertaAlaskaAlabamaArkansasArizonaBristish ColumbiaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachussettsManitobaMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNew BrunswickNorth CarolinaNorth DakotaNebraskaNewfoundland & LabradorNew HampshireNew JerseyNew MexicoNova ScotiaNorthwest TerritoriesNunavutNevadaNew YorkOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSouth CarolinaSouth DakotaSaskatchewanTenesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingYukonAmerican SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin IslandsArmed Forces AmericasArmed Forces Middle EastArmed Forces Pacific
Telephone Number:
CREDIT CARD BILLING ADDRESS (same as Shipping Address )
Address:
City, State, Zip:	Select a State AlbertaAlaskaAlabamaArkansasArizonaBristish ColumbiaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachussettsManitobaMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNew BrunswickNorth CarolinaNorth DakotaNebraskaNewfoundland & LabradorNew HampshireNew JerseyNew MexicoNova ScotiaNorthwest TerritoriesNunavutNevadaNew YorkOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSouth CarolinaSouth DakotaSaskatchewanTenesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingYukonAmerican SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin IslandsArmed Forces AmericasArmed Forces Middle EastArmed Forces Pacific
Telephone Number:
I approve the above order. Please call me to confirm my order and I will have my credit card ready for payment.