Arbor House, 3501 New York Avenue, N.E., Washington, DC 20002-1958

Name__________________________________________________________________

Address 1:______________________________________________________________

Address 2:______________________________________________________________

City________________________________________State_____Zip_______________

Telephone_________________________  Email_______________________________

	Item #	Description and/or name	Qty	Price	Total
1
2
3
4
5
6

      Packing & shipping charges (domestic addresses only):                                        

Orders up to $20.00	$5.50
$20.01 to $35.00	$6.75
$35.01 to $50.00	$8.75
$50.01. to $65.00	$9.75
$65.01 to $80.00	$11.75
$80.01 to $100.00	$13.75
Over $100.00	$15.75

                                    Subtotal  __________ 
Packing & shipping  __________
Shipping to additional                     
addresses ($4.00 each)__________
(For shipments to District of                                    Columbia, add 5.75% sales Tax)__________

Total Order  __________

 
o  Check enclosed (Do not send cash)    Charge:  oVISA     oMasterCard 

Expiration date:________________ Signature____________________________________________