P.O. Box 523
Germantown, MD 20875
Tel/Fax: 240-477-5451
E-mail: rapport1@verizon.net
ORDER FORM
You may also download this order form as a pdf file. Click here TODAY'S DATE: __________________________











Quantity Item No. Description Price Each Amount
         
         
         
         
         
         
         
         
Important: Do NOT e-mail your order! Use our secured FAX line for credit-card orders or use U.S. Post Office mail for orders paid by check or credit card. Sub Total  
Shipping / Handling  
Sales Tax (If Applicable)  
Grand Total  

Shipping / Handling costs for order amount up to:
$ 10.00 add $1.50 $ 75.00 add $5.00 MAIL YOUR ORDER TO:
     Starfire, P.O. Box 523 Germantown, MD 20875

Or Fax your credit-card order to our secured line:
     1 - 240-477-5451
$ 25.00 add $3.00 $ 100.00 add $6.00
$ 50.00 add $4.00 Over $ 100.00 add $7.00

Charge my:
_____ Visa       _____ MasterCard
_____ Check or Money Order Enclosed.
(Sorry, no C.O.D.’s)

Credit Card # ____________________________ Expiration Date: _________________
Cardholder’s name, exactly as it appears on card: _______________________________
Daytime Phone Number: (_____)_____________________
E-mail: _______________________________

How did you learn about this product? __________________________________________

SHIP TO:
Name: __________________________________________________________________
Street: __________________________________________________________________
City: _____________________________________ State: _________ ZIP: _____________

Billing Address and exact name of Credit Card Holder as it appears on the card if different from the above:
Name: __________________________________________________________________
Street: __________________________________________________________________
City: _____________________________________ State: _________ ZIP: _____________